@drsuefowler I hope you can get up to 70mcg or at least 60. I was worried for you with 20mcg! My CTX came down well with 6-7 clicks. We are similar in vulnerability to fractures (I have 7 spinal fractures) and since starting Tymlos haven't had any. I know 40mcg may be therapeutic to some extent but my experience was that I went from not tolerating 40mcg to tolerating 70mcg by ramping up. I was NOT side effect free but very tolerable. Hope you can!