I stopped Tymlos after 6 months last October. I couldn't take all the side effects. I never really got beyond 4 clicks (once or twice on 5). In that short time my spine numbers (trabecular) increased (spine was not the problem), and one hip increased and one hip decreased (cortical). To answer your question at the end: since the goal of the bisphosphonate is to "lock in" gains, the sooner you start on it the better. My endo told me I could/should start immediately, but I took a week or two just to give myself a moment without taking anything. I struggled a lot with Tymlos, got wonderful support from people on this site, but ultimately I couldn't do it. Also, my hair (not all) fell out. I just couldn't do it.