Hi @rajmayo22 - Great to hear things are going well on Tymlos. Tymlos seems to be a very effective drug for most people.

The drug you use next should be based upon your T-scores just as you finish your current treatment. Perhaps a month or two before your Tymlos treatment ends, get a DXA scan. Depending on your results, the best path might be Fosamax, Prolia, or perhaps Evenity. It all depends on where you are at at the end of your current treatment.

CTX and P1NP would be nice to have but I would not lose sleep if you can't get it. Since you are on drug now, it's not going to represent your baseline. It will not be super helpful IMO.

The other drugs you are on don't stand out to me as a problem, but this is not my area of study.

Let us know how your DXA turns out. I'm sure you will get a lot of advice on a follow-on solution. 🙂

rajmayo22, it's a really good idea to get the bone markers. CTX is most useful for determining bisphosphonate use. Tymlos doesn't raise osteoclasts (CTX) in the way that Forteo does. A low CTX would encourage the provider to extend Tymlos use rather than starting Fosamax. Significantly, too would be the second CTX after a month or two of Fosamax to determine it the medication is benefitting your bones. The risks with Fosamax are small. But why take a med that is all risk and no gain.
I recommend P1NP as well. Though there isn't controlled clinical data, more thinking phsicians, or physicians (and patients) who are thinking are considering the balance between CTX and P1NP to determine best levels of CTX.
Information from your bone markers would benefit your treatment plan. And mine, if you post them.