Evenity Side Effects: Risks, Management & Comparison

If you’re weighing Evenity (romosozumab) for osteoporosis, you want clear, trustworthy info on Evenity side effects. This guide summarizes what’s common vs. serious, who should be cautious, how to manage symptoms, and how Evenity’s safety compares to Prolia.

Quick answer: The most common side effects are joint pain and headache. Rare but serious risks include heart attack or stroke (FDA boxed warning). In the U.S., do not start Evenity if you’ve had a heart attack or stroke in the past year; stop treatment if either occurs. Call 911 for chest pain, one-sided weakness, or trouble speaking. Typical course is 12 monthly doses, then switch to another medicine to maintain gains (FDA prescribing information).

Note: Educational only—not medical advice. Always speak with your clinician about your situation.

Key takeaways (at a glance)

• Boxed warning (heart and brain): Evenity may raise the risk of heart attack, stroke, and cardiovascular death. Don’t start it if you’ve had a heart attack or stroke in the last year (U.S. label) (FDA prescribing information), and stop treatment if either occurs. Note: requirements differ by country; Australia applies stricter contraindications (TGA update).
• Most common side effects: joint pain and headache. According to guidance from the American College of Rheumatology (ACR), joint pain occurs in about 8–13%, headache in ~5–7%, and injection-site irritation in ~5% (ACR patient guidance).
• Less common but important: low blood calcium, severe jaw problems (osteonecrosis), atypical femur fractures, and severe allergic reactions (FDA prescribing information).
• Treatment plan: Usually 12 monthly doses (two back-to-back shots each month), then transition to an antiresorptive to keep the bone gains you made (StatPearls).

What is Evenity—and why consider it?

Evenity is a lab-made antibody that blocks sclerostin, a signal that puts the brakes on bone building. Blocking it helps you build bone faster (and also slows breakdown a bit). Dosing is 210 mg once monthly—given as two injections back-to-back—for up to 12 months, typically with daily calcium and vitamin D (FDA prescribing information).

In a large study of 7,180 postmenopausal women (FRAME), Evenity reduced new spine fractures by 73% at 12 months vs placebo, and the benefit persisted after both groups moved to denosumab in year two (NEJM FRAME trial).

Boxed warning: cardiovascular risks

• The U.S. label warns of possible heart attack, stroke, and cardiovascular death. Do not start if you’ve had a heart attack or stroke within the past year, and stop if either happens during treatment (FDA prescribing information).
• Country differences: Australia’s TGA notes any prior heart attack or stroke is a contraindication (TGA safety update).
• Call 911 for chest pain, shortness of breath, sudden weakness or numbness on one side, trouble speaking, or vision changes (Evenity safety info).

Common side effects (and how often)

• Joint pain (arthralgia): ~8–13%
• Headache: ~5–7%
• Injection-site pain/irritation: ~5%

Sources: ACR patient guidance; Evenity safety info.

Other mild reactions can include muscle spasms and swelling of hands/feet; check in with your clinician if these persist or worsen (Cleveland Clinic overview).

Serious but uncommon risks

• Low blood calcium (hypocalcemia): risk is higher with severe kidney disease or dialysis. Correct low calcium/Vitamin D before starting and monitor during treatment (FDA prescribing information).
• Osteonecrosis of the jaw (ONJ): get a dental exam before therapy, report jaw pain or poor healing, and avoid elective invasive dental work during treatment when possible (FDA prescribing information; Cleveland Clinic overview).
• Atypical femur fractures: report new or unusual dull aching in the thigh, hip, or groin right away (FDA prescribing information).
• Severe allergic reactions (anaphylaxis/angioedema): get emergency care for swelling of the face/lips/tongue/throat, trouble breathing, or hives (Mayo Clinic monograph).

Who should avoid or use caution with Evenity?

• Don’t start if you’ve had a heart attack or stroke in the past year (U.S. label) (FDA prescribing information). In Australia, any prior heart attack or stroke is a contraindication. In an alendronate-controlled trial, major adverse cardiac events were 2.0% with romosozumab vs 1.1% with alendronate; during the 12-month romosozumab phase, heart attack occurred in 0.8% vs 0.2% and stroke in 0.6% vs 0.3% (TGA safety update).
• Correct low calcium first; ensure adequate calcium and vitamin D intake (FDA prescribing information).
• Severe kidney disease/dialysis: higher hypocalcemia risk—monitor closely (FDA prescribing information).
• Known allergy to romosozumab or its ingredients (FDA prescribing information).
• Pregnancy/breastfeeding: not recommended; discuss risks with your clinician (FDA prescribing information).
• Men: In the U.S., Evenity is not approved for men; some regulators (e.g., Australia’s TGA) do approve it for men at high fracture risk—confirm local indications with your clinician (StatPearls; TGA safety update).

Symptom Management: When to Seek Medical Help

• Mild symptoms (e.g., headache, small injection-site redness): track for 24–48 hours; try hydration and rest. Call your clinician if persistent or bothersome (ACR patient guidance).
• Possible low-calcium signs (numbness/tingling around lips or fingertips, muscle cramps): call your clinician promptly for a calcium check (FDA prescribing information).
• Dental/jaw symptoms or dull aching in thigh/hip/groin: pause high-impact activity and contact your clinician or dentist; you may need imaging or dental evaluation (FDA prescribing information).
• Emergency signs—call 911: chest pain, shortness of breath, one-sided weakness/numbness, trouble speaking, facial droop, or severe allergic reaction (Evenity safety info; Mayo Clinic monograph).

Evenity vs. Prolia: Side Effect Comparison

Practical ways to lower risk while on Evenity

• Stay on top of calcium and vitamin D (ask your clinician about targets for you). Our guide explains the benefits of Vitamin D3 and K2 for bone and heart health in more detail.
• Get a dental exam before starting; keep excellent oral hygiene and tell your dentist you’re on Evenity (FDA prescribing information).
• Manage heart risk factors (blood pressure, cholesterol, smoking cessation, activity) with your primary-care clinician (TGA safety update).
• Build fracture resilience with strength, balance, and posture training, with step-by-step guidance in Strength training for bone density.
• Track bone health with DEXA and discuss fracture-risk thresholds with your clinician. For testing logistics, see our resources:
  • Guide to bone density testing
  • When should women get a bone density test?

FAQs

• How long can I take Evenity? The approved course is 12 monthly doses. After that, most patients transition to an antiresorptive medication to maintain gains (FDA prescribing information; StatPearls).
• Is Evenity used in men? In the U.S., Evenity is not approved for men. Outside the U.S., some regulators approve romosozumab for men—confirm local indications with your clinician (e.g., Australia’s TGA) (StatPearls; TGA safety update).
• I have kidney disease—can I still use Evenity? Evenity can cause or worsen hypocalcemia, especially with severe kidney impairment or dialysis; you’ll need careful calcium/vitamin D management and monitoring (FDA prescribing information).
• What dental steps should I take? Have a dental exam before starting, prioritize routine care, avoid elective invasive dental procedures during therapy when possible, and alert your dentist you’re on Evenity (FDA prescribing information).

The bottom line

Evenity can build bone quickly and reduce fracture risk, but it carries important safety considerations—especially cardiovascular risk. With the right screening, monitoring, and follow-up plan, many people can use it safely and effectively.

If you’re evaluating therapy, one smart next step: track your bone density and body composition changes over time with a BodySpec DEXA scan (Book a BodySpec DEXA scan).