Evenity (romosozumab) is given as two subcutaneous injections once a month for 12 months. Each monthly dose totals 210 mg, split across two separate prefilled syringes of 105 mg each. The injections are given just under the skin in the abdomen, thigh, or upper arm, and the two shots should be administered at different sites during the same visit.
What Each Monthly Visit Looks Like
Evenity is administered by a healthcare professional, not self-injected at home. Each appointment is brief. You’ll receive two injections, one right after the other, in two different locations on your body. The approved injection sites are the stomach area, the front of the thigh, and the outer area of the upper arm. Your provider will rotate where the shots go from month to month.
Before injection, the medication needs to sit at room temperature for at least 30 minutes. It’s stored refrigerated between 36°F and 46°F in its original carton to stay protected from light. Injecting it cold can be uncomfortable, so this warming step matters for your experience.
The 12-Month Treatment Course
The full course of Evenity is 12 monthly doses, totaling 12 visits over one year. This is a fixed duration, not an ongoing medication. The bone-building effects of Evenity are strongest during this window, and extending treatment beyond 12 months is not recommended.
If you miss a scheduled dose, you should get it as soon as possible and then reschedule your next dose one month from that date. Consistency matters because the drug works by actively stimulating new bone growth while simultaneously slowing bone breakdown. That dual effect is time-limited, and gaps in treatment reduce the benefit you get from the full course.
How Evenity Works in Your Bones
Evenity is the first osteoporosis drug that both builds new bone and slows bone loss at the same time. It works by blocking a protein called sclerostin, which your bone cells naturally produce to put the brakes on bone formation. When sclerostin is blocked, the cells responsible for building bone (osteoblasts) become more active, while the cells that break bone down (osteoclasts) slow their work. This dual action is what makes Evenity different from older osteoporosis treatments, which typically do one or the other but not both.
What Happens After 12 Months
Evenity is not a standalone treatment. Once you finish the 12-month course, your provider will transition you to a different type of osteoporosis medication that prevents bone loss, such as denosumab or zoledronate. This follow-up step is essential. Without it, the bone density you gained during treatment can decline. Data from the FRAME clinical trial showed that patients who moved to a bone-preserving medication after completing Evenity maintained low fracture rates into the second year and beyond.
Even patients who don’t complete the full 12 months of Evenity still benefit from transitioning to follow-up therapy. In a study of 26 patients who switched early (after a median of six injections rather than twelve), bone density improvements during the first year were similar to those seen in patients who finished the full course, as long as they moved to an appropriate follow-up medication.
Cardiovascular Safety Warning
Evenity carries an FDA boxed warning for potential risk of heart attack, stroke, and cardiovascular death. It should not be started in anyone who has had a heart attack or stroke within the past year. If either event occurs during the 12-month treatment course, the medication is stopped immediately. For patients with other cardiovascular risk factors like high blood pressure, high cholesterol, or a history of heart disease, providers weigh the bone-building benefits against this risk before prescribing.
Calcium and Vitamin D During Treatment
Because Evenity ramps up new bone formation, your body’s demand for calcium increases. Low blood calcium (hypocalcemia) is a known risk, particularly in people who already have low calcium levels before starting. Your provider will check your calcium levels and correct any deficiency before your first injection. Throughout the 12-month course, you’ll be advised to take adequate calcium and vitamin D supplements daily to support the accelerated bone-building process.