@ripley try the full dose first. If you cannot tolerate it, go down to two clicks but try to move up as fast as you can. Doctors do not know about this but when it helps patients get on the medications, they are on board. They cannot prescribe this: it wasn't studied.

I would think one click is useless. Four might help (1/2 dose) but better to try to get to at least 6 or 7.

This whole suggestion of lowering dose was intended to help people get on to a therapeutic dose by helping the body get used to it, but it was not suggested to take a low dose long term.

Basically, it's better than quitting altogether. If full dose is too much try 1/2 dose before going down to 2 clicks which is probably useless unless only used to get up to more.

At 18 months on Tymlos my spine went from -3.7 to -2.5 (20% gain, from severe to borderline). My hip went from -3.3 to -2.9 (9 % gain). Femur neck from -4.1 to -3.6 (still a concern). It should be noted that I had not taken any meds before this. I mostly did 7 clicks out of 8.