Evenity versus Tymlos choice

Happytrails, Tymlos. The osteosarcoma warning has been determined to be unfounded. The referenced mice in the study were prediposed to bone cancer.
Evenity has it's temptations. It is too new. Someday, maybe, research will discount the cardiac warnings. I haven't taken either medication.
If this were a multiple choice question I would choose Forteo. But Tymlos is close.
I've been on Forteo a little over a year, Tymlos is thought to be more effective with BMD and to have less of an excitatory effect on the cells that break down our bones than Forteo or Evenity. Tymlos works better if taken before Evenity and after a year of Evenity you'll be struggling with the question of what ot take next.
I do wish your provider had explained about the mice instead of reveling in the fact that you are not one. Anyway it was a rat--the Wistar Rat.
From the voice of inexperience, bless your choice.

Thank you so much for this reply!

I've come across some reputable osteoporosis doctors on YouTube who teach at medical schools, and they've posted in the last six months that that the risk of osteosacrcoma is a factor to consider.

And Mayoclinic.org also repeats the point that Tymlos may increase your risk of osteosarcoma.
https://www.mayoclinic.org/drugs-supplements/abaloparatide-subcutaneous-route/side-effects/drg-20406221?p=1
Regarding Evenity v. Forteo: Evenity is in the same group as Forteo, so another of my doctors (who was one of the doctors who years ago was asked by the FDA to assess Actonel) believes that the track record for Forteo applies to Evenity as well. So he does not think of it as a new drug.

The pont you make about what next if I take Evenity is a good one. I have been seeing on this forum that one can take Evenity after taking Tymlos but not the other way around.

I do appreciate your reply! I moved, and my current doctor is pretty matter-of-fact about my taking Tymlos. It's not pressurng, but they are not getting into Tymlos v. the alternatives. So your feedback helps, thanks!

happytrails123,
part of the trouble with the internet is the outdated information. If you look at the dates on those videos, you'll see. The label change is new and it takes a while to catch up, but even the package inserts still contain outdated information. And the university websited say updated, but they aren't. Plus they often don't cite study origins, so you can't check to see patient selection and patient number.
The black box was removed from Tymlos in 2022.

Since most of us will die of heart disease, I don't find Evenity attractive.
I don' t like the mechanism by which it is effective. It basically blocks the production of sclerostin-- a protein long thought to prevent plaque accumulation in the cardiac valves. The pathway that romosozumab blocks is also used by neurons in the brain to preserve memory and cognitive function.

Like with Prolia, though, we do need volunteers to test these newer drugs because drug trials are costly.
Joking aside, many Evenity users have had success with the medication.

Thank you @gently . This is useful information.

Isn't Forteo also associated with adverse heart events in trials? I thought Forteo and Evenity were alike in that respect.

But yes Forteo has been around longer than either Tymlos or Evenity.

Also, doesn't Forteo have an osteosarcoma risk? Or was that disproved also?

Do you need to follow Forteo with a biphosphonate or lose the benefit of the bone you built? Or is that true for all the drugs- Evenity, Forteo, and Tymlos?

Many thanks!

https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1220174/full
Low incidence with Forteo, not MACE, but arrythemias. that can lead to afib.
One nice thing about Forteo and Tymlos is that you can quit the medication overnight. That's because of the not so nice thing that you inject it everyday. With Evenity, if you have side effects, you are stuck for a while-- 64 days.
Some can't take Forteo or Tymlos
No osteosarcoma risk with Forteo. Yes, also disproven.
Forteo has to be followed but some are following with Forteo, now that the 18 month limit has been removed.
No matter what you decide, be sure and have bone markers CTX and P1NP before you start and during treatment to make sure the medication is helping your bones.
More, questions please.

@happytrails123 Forteo and Tymlos are similar and work through the parathyroid. They are different from Evenity, which inhibits sclerostin, as @gently explained.

Not a single human has gotten cancer/sarcoma on Tymlos or Evenity, and the black box warning has been removed from both. You are not the only one getting info that is old!

Evenity was studied in comparison with placebo for cardiovascular risk and there was no difference. Compared to alendronate, however (Fosamax) it had slightly more risk. There was a theory that this was because alendronate was slightly protective, and another theory that it was due to chance!

I chose Tymlos (adjustable dose) for two years followed by Evenity (I only did 4 months). All of these drugs need to be followed by a bisphosphonate like Reclast or Fosamax to "lock in" gains.

You can read Keith McCormick's book "Great Bones" or watch Dr. Ben Leder's video on YouTube on Combinations and Sequencing but sometimes too much research can be counterproductive 🙂

Thank you! I am especially interested in these videos on sequencing. I took Actonel for 4.5 years, off of Actonel for 3 years now, and I have read that Evenity and Forteo/Tymlos will be less effective when followed by Actonel, which is too bad.

I will see my doctor at the medical school tomorrow and ask her about this.

Thank you very much! I took Actonel for 4.5 years (I've been off it for 3 years now). I read that Evenity, Tymlos/Forteo will be less effective because of my prior Actonel use.

Tomorrow I will ask my doctor if one of these drugs works better after taking Actonel.

Many thanks,

@happy trails those drugs are still effective, just less so. For instance I read in one study that Evenity improved bone density 16% for those who have not taken a bisphosphonate, and 10% for those who have. You have been off for 3 years-maybe that helps-? Your doctor will tell you more. Dr. Ben Leder discusses this in his YouTube video Combinations and Sequencing Approaches to Osteoporosis.

I am searching for the results of taking Forteo over a year and how much it helped with DEXA score