Tymlos vs Prolia

I am new to this forum and just saw your question. But I wanted to post this response in case anyone can benefit from this information. I know I am glad I found this today because it will change which medication I will begin with.

Fosamax is contraindicated when dental work is to be done that involves dental bone remodeling which occurs with tooth extraction, dental implants or orthodontic treatment. There have been reports of necrosis of the jaw bone when using Fosamax and undergoing these dental treatments. So for some persons this may be a reason they don't use Fosamax first and instead begin with a bone-building medication.

I don't believe this includes dental fillings, crowns or root canals, but please ask/verify with your dentist.

Your question is an important one because when using the these two types of osteoporosis medications (bone building and anti-resorptive medications) one type can affect the benefit/gains of the other.

For reference I will refer to two types of medications below.

The antiresorptive drug is alendronate (brand name Fosamax)
The bone-building drugs are teriparatide (brand name Forteo) and abaloparatide ( brand name Tymlos)

Here is how antiresorptives affect bone-building medications:

Concomitant or prior use of alendronate (Fosamax- anti-resorptive medication), but not raloxifene or estrogen, BLUNTS the effects of teriparatide (Forteo - bone building medication).

The optimal alendronate holiday prior to instituting teriparatide is UNKNOWN, but probably will be at least 6 months.

An antiresorptive should be added AFTER a course of teriparatide is completed to PREVENT loss of bone mineral density (BMD) gains from teriparatide.

Hello Chris, I am thinking of doing the same thing, using a bone building medication first like Tymlos, followed by an antiresorptive like Fosamax in order to maintain the bone building gains Tymlos provides.

Why did your dr start you on Tymlos first? I ask this because so many patients seem to be started on Fosamax which is not a bone builder like Tymlos.

For reference, my T-score on my hips are -2.7 and -2.8 on the other. I am in my 60s.
Were your T-scores similar when you began your Tymlos?

What kind of dr did you use when you initiated the use of Tymlos, a GYN, general dir, orthopedist or an endocrinologist?

It's hard to figure out who to go to because the main thing is one does not always know the dr's philosophy/approach about treating osteoporosis or if they are fully immersed in understanding it. How does one navigate finding a dr that fits your needs? I which they had a comprehensive 'label' of sorts so we could know before we make an appointment.

Thank you.

@healthmatters your hip scores are mild osteoporosis, (what are your spine scores?), so one issue is that insurance probably won't approve Tymlos, Forteo or Evenity. Insurance is a big problem with the sequencing that so many experts discuss.

With scores like yours, some docs will prescribe Fosamax and some will be open to more "natural" or "holistic" approaches. Maybe buy a book by Keith McCormic entitled "Great Bones" or his earlier book, "A Whole Body Approach to Osteoporosis." Margaret Martin is great on exercise at melioguide.com. Lani Simpson, Doug Lucas. And discuss with your doctor.

Drugs like Fosamax do affect the effectiveness of bone builders, but the bone builders are still helpful. I have read that impact with Evenity, for instance, is 10% vs 16% for "treatment naive" patients.

To me, the biggest issue with milder osteoporosis scores is long term planning. So say you can be on Fosamax for 3-5 years, then what? Tymlos is two years, Forteo is now 4 years total, Evenity is one year, and Prolia really should be only a year and a half or so to avoid rebound risk, and can only be used with transition to Reclast or Fosamax. Add those years up and say you are 60. What do you do in your 70's and 80's? Noone has answered that for me as yet. I think that might be a good reason to delay meds if osteoporosis is mild, as long as the person is safe and the doctor agrees.

But that's me and I am not knowledgeable on this issue of duration of treatment. Perhaps, after Tymlos and Evenity, then Reclast, I will be able to repeat this sequence again, have drug holidays, do bursts of bone builders between bisphosphonates- time will tell.