Confused by doctor options to choose, including Keith McCormick

Interesting to hear different doctors' take on which med. The doc I consulted is pretty experienced in treating osteo for years now. The recco for me was to take Tymlos. I asked about Evenity and doc had strong opinions against it - won't prescribe or recommend Evenity to patients right now. Feels it's still too new, without enough real-world results yet and is leery on the elevated heart risks seen in some patient results.

This doc is fairly cautious/conservative though. So take that for what it's worth. As we know, other docs feel differently. Is it any wonder we're confused? lol

For the person asking about a Mayo consult via zoom - they refused when i tried. They said first appt MUST be in person, regardless of where the patient lives. Won't do virtual. 🙁

I agree with those who have the opinion that Evenity is too new and not studied enough and though my endocrinologist wants me to take it and feels that if you have no heart issues to begin with then you should be able to safely take it, I am prone to chest pain and so I think being on events would be very stressful for me. I also have had IBS since 2005 so I am wondering if Forteo would exasperate digestive problems like that. Or if Tymlos would be less apt to do that. My primary says that Forteo is the way to go because it builds bone but if it causes me stomach issues I can just go off it. However once you go on it you can stop it but then you have to immediately start something else and I guess that would be Recast. If you can tolerate Recast-great but then after a few years you have to stop taking it, and then what?? I've got an appt to be evaluated for Onero. I hope that's the answer because other than that I'm not sure. I've been on Fosamax for two years about twenty years ago and have had acid reflux ever since. I'm a 72 year old granny with severe osteoporosis and I've been on a lot of supplements for osteoporosis for the past two years and have broken my hip by a fall two years ago and so far for the past three years have been stable with my Dexa Scans, praise God. I'm not too dedicated to exercise because it's difficult for me. But I'm persevering!!!

I agree with those who have the opinion that Evenity is too new and not studied enough and though my endocrinologist wants me to take it and feels that if you have no heart issues to begin with then you should be able to safely take it, I am prone to chest pain and so I think being on events would be very stressful for me. I also have had IBS since 2005 so I am wondering if Forteo would exasperate digestive problems like that. Or if Tymlos would be less apt to do that. My primary says that Forteo is the way to go because it builds bone but if it causes me stomach issues I can just go off it. However once you go on it you can stop it but then you have to immediately start something else and I guess that would be Recast. If you can tolerate Recast-great but then after a few years you have to stop taking it, and then what?? I've got an appt to be evaluated for Onero. I hope that's the answer because other than that I'm not sure. I've been on Fosamax for two years about twenty years ago and have had acid reflux ever since. I'm a 72 year old granny with severe osteoporosis and I've been on a lot of supplements for osteoporosis for the past two years and have broken my hip by a fall two years ago and so far for the past three years have been stable with my Dexa Scans, praise God. I'm not too dedicated to exercise because it's difficult for me. But I'm persevering!!!

If your bone density scan shows severe osteoporosis, you have those three choices: Forteo, Tymlos and Evenity, all of which build bone. I chose Tymlos because the injection pen has "clicks" allowing the dose to be adjusted. I started at a lower dose and moved up as my body adjusted. But that's me and I was too sensitive to Forteo. Another poster will say they were better with Forteo. It is very individual.

McCormick in his book "Great Bones" and others have said Evenity is great if you need to improve fast. Sounds like that might be you. On the other hand Tymlos and Forteo are good for healing and you can take Evenity after Tymlos or Forteo.

It sounds like you are in a bit of dangerous predicament so a strong bone builder that works fast, like Evenity, isn't a bad idea but talk with your doctor.

The study on cardiovascular risk showed no difference between Evenity and placebo but Fosamax was slightly better, possibly due to chance. I do think the various effects of inhibiting sclerostin need more investigation but most people are doing really well on Evenity. (I did Tymlos then 4 months Evenity and now Reclast.)

Further- My research has told me Forteo is better to increase density of the spine versus Tymlos . And Tymlos does a little better than Forteo at the hip. This was the very reason I choose Forteo. Everyone is different , and that I’m sure plays into this . Below are the value’s DrMcCormick states in his Great Bones book. Though he’s an expert, others may disagree with him.

In the first two years:

Approximate increase in SPINE BMD
FORTEO- 10-12 %
TYMLOS - 9-10%

Approximate increase in HIP BMD
FORTEO- 1.5-2%
TYMLOS - 2-3%

I agree with your primary. Forteo is unlikely to cause stomach issues. Whatever effects it casuses should go away within 24 hours as the medication (unlike many others) leaves your system quickly. as your primary informs us, you just quit taking it. Tymlos is a similar medication with slightly higher increase in BMD. You could be allergic to one or the other and can readily switch if you had problems with Forteo.
I'm a little older than you are and have been taking Forteo for over a year without adverse effect. I recommend Forteo (all the time, excessively) because I've had such a good experience with it. For some it is intolerable. You lose gains with Forteo when it is stopped, but it is a much slower loss than Evenity or Prolia. And you don't lose lower than baseline. You might though consider getting Bone Markers (CTX, P1NP) to be certain that Forteo is working for you. One set before starting and one set at two months.
Forteo was previously limited to 18 months. Now, patients are extending use to commonly 3 but I've heard of six years. Keep persevering and posting. Let us know what you decide and how it works.
Nausea was signaled in the clinical trials of Forteo. The thinking is that this is caused by shifting calcium levels. It is said that this adverse reaction resolves in the first week as your body adjusts . i never had any, and hope you wouldn't either.
Forteo and Tymlos both build bone. Reclast, all the bisphosphonates and Prolia work by preventing older bone from remodeling. Tymlos and Forteo increase BMD more rapidly. And it is good strong new bone.