Hi @drsueflower, I'm on forteo therapy now. At 13 month, my dexa showed 4.5%improvement at L spine. However, dexa reading had a closer to 8% decrease in bmd at hip/femoral neck. The conflicting results puzzled me for a while. In recent months, the dexa was reexamined and showed there were technical errors involved. My endo concluded that there had no changes in hip or femur neck for me, while L spine indeed improved 4.5%. This is a great news to me since my main problem is spine area.

The clinical studies shows that forteo indeed has largest impact on trabacular bones, so are other 2 anabolics tymlos and evenity. For hip and femur neck, evenity seems having largest impact, then tymlos then forteo. There are variations among population. If one individual had a good results with one drug, it does not mean the result will be the same for another. The results from various trials are average among the population the tested.

I'm wondering your tymlos' dose. Tymlos is a similar drug compared to forteo. For fair comparison, a 20mcg forteo is more or less comparable to a full dose of tymlos at 80mcg, not at a lower dose, although tymlos dose could be adjusted/titrated for those who need it due to severity of side effects. To be fully effective against future fracture, you might be needing a full dose of tymlos, 80mcg. Discuss this with your doctor.

Also bear in mind that a dexa reading itself might not reflect the true bone strength. There aren't good measure for bone strength. Both "tymlos and forteo increase the periosteal and endosteal perimeters, resulting in a larger, more structurally sound bone", this may not shown in bmd increase in dexa scan. But the fracture reduction is evident in clinical trial for both drugs, with tymlos showing a slight advantage.