Looking ahead after Tymlos: Reclast, Evenity or HRT?

Psnmonna,
so Tymlos works by temporarily raising parathyroid levels. High PTH causes rapid heartrate. There is a sequence the Tymlos causes vasodilation. Vasodilation lowers blood pressure. Low blood pressure raises heartrate and the heart beats faster to make up for the low pressure. You might hydrate more so the heart doesn't work so hard. Salt constricts the blood vessels so I like to use it as an excuse to eat a couple of blue corn chips, or salted cashews. If the back and shoulder pain recur, you might get a cuff to measure the heart rate because tachycardia can cause afib and afib can cause cardiac remodeling. Your md is almost certainly right to say-- don't worry. The effect may lessen as your body adjust to the medication.
You could take estradiol in addition to Tymlos. I'm partial to the low dose patch for safety, though I don't use it myself.
Your doctors are planning Reclast for two years. The cognoscenti know that one year is good for two years. And the 4mg zolendronates. works just as well as the 5mg Reclast dose. The groundlings are planning month break and then a third year of Tymlos.
And the researchers https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(24)00266-0?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2666379124002660%3Fshowall%3Dtrue

Gently - very interesting article on Pepitem. Something I will do more research on. As for Reclast, one year or two? Will one infusion of Reclast stay active for 2 years?
Thanks for your thoughts.

According to the bone expert who ran the clinical trials, one year of Reclast. Reclast is said to stick to the bones for ten plus years. According to a pathologist reclast sticks to the bone for almost ever. He said it attaches in mottled form not evenly like a good stucco job. The effect of an anabolic taken after reclast will be blunted. You might be thinking about say Forteo after the bisphosphonate. So the bone expert is recommending risidronate after Forteo for me. It has the least adhesion time of the bisphosphonates.
I'm glad you have a year to decide.

@psmnonna I usually have episodes of afib that land me in the hospital, once or twice a year. For the two years on Tymlos I didn't have a single episode- despite the rapid heart rate that lasts a short time. I hope that is reassuring.

Time on Reclast varies after Tymlos. Some do one year. I was told 3, because my bones need more density (despite my going from severe to borderline in spine on Tymlos, my hip is still -3.6, up from -4.1). Also, if you do a lower dose of Reclast, you might do it more than once/year.

@gently Thank you for such great information this morning!!
I am also curious and wonder if the reason your dr is recommending Actonel (Risedronate) as a follow up to Forteo is cause you want to have the least amount of years on these meds OR because it provides you the most option to redo an anobolic in the future if need be???

I do plan on repeating Forteo. I'd like to skip the bisphosphonate altogether. And that is the reason for the risidronate suggestion the shortest adherence time, so the briefest interference with repeat Forteo. There aren't trials on longer use of teriparatide because of the original black box. My thought is to take Forteo breaks with no intervening medication. It currently looks as though a month break is too long. I have another year of Forteo.
I haven't found an endocrinologist who actually likes the idea.
I did find a pathologist (cadavers only) who thinks it's brilliant and wants me to send him my bones when it becomes convenient.

For me, Tymlos, which is of course similar to teraparatide, pooped out before 18 months. Bone markers supported this. Even if I took a break, not sure Tymlos would be active in time. I am interested in locking in my gains so far and was told risendronate was a weaker option compared to alendronate or Reclast.

I get that that's the point @gently is making: that a weaker anti-resorptive might make a second course of Forteo more effective. Its relative weakness might also mean loss of bone density in the interim. We don't know the time interval needed for Forteo or Tymlos to then make up for that loss.

Evenity and Tymlos or Forteo have reduced effectiveness after a bisphosphonate, but effectiveness is still there.

I would be afraid to lose more density by waiting for a second Forteo or Tymlos course (which might not be effective, no studies on this) or by using risendronate- thatnI would lose in terms of reduced effectiveness of anabolics after Reclast.

Just thinking out loud here. I would like more research on how a second course of an anabolic might happen.

windyshores, I depend on your more seasoned voice to moderate my posts. Thank you.

@gently I find your ideas on this interesting and wish there was more research! Until there is, I am going to be cautious and do Reclast, hoping a low dose accomplishes both "locking in" and making a second course of anabolic possible.

Of course Tymlos is not approved for more than two years as yet and I could not tolerate Forteo so it may be a moot point 🙂

I hope you will let us know how risendronate works for you in terms of a second course of Forteo being more effective.

I'm glad your afib subsided and hope it has not returned! I think my rheumatology doc is leaning to reclast.
Unfortunately I had no bone markers done before starting Tymlos. Actually never heard of them until reading posts here. Would love to have had that knowledge before so I could've had some sort of baseline before starting any med. Wish bone markers were a required standard like dexa is....but that's another discussion.
Reading your post below I also was unaware that Tymlos or Forteo begins to wane in effectiveness before the full 2 yrs. I'm not excited about reclast as a future option as I'm not sure bisphonates really strengthen bone or just patch in random holes like spackle. Form without substance so to speak.
One would think that a disease that 10 million people have in the US would have more significant/effective treatments by now.
Thank you for your expertise!