I could not tolerate Forteo. I liked Tymlos because the dosing pen is adjustable. I started with two clicks- full dose is eight. And as my body adjusted, I increased, finally reaching 7 our of 8 clicks in two months or so. I rarely too full dose but had excellent gains. My spine went from severe (-3.7) to borderline (-2.5).

For a score of -3.4 it isn't really complicated. There are three choices that build bone with quality: Forteo and Tymlos are similar drugs and work through the parathyroid. Evenity is the third choice and works fast. It inhibits sclerostin and is a bone builder for the first half. Like Fosamax etc. it is anti-resorptive for the second half.

In my experience Tymlos lost its bone building strength by 18 months. I maintained on it for another 6 months. I then did 4 months Evenity. After any of these three, many of us will do Reclast or Fosamax to "lock in gains." Some go on Prolia but there is a rebound if that is stopped and you would need Reclast.

@gently has the idea of doing a weaker bishosphonate because once a bisphosphonate is used, the three bone building drugs are less effective so she is trying to minimize that effect. My doctors want me on a stronger bisphosphonate to better "lock in" gains. As with everything in osteoporosis, these are contradictory ideas and we need research.

But worry about that later! Forteo, Tymlos or Evenity! I chose Tymlos followed by Evenity.