Taking Tymlos but Forteo recommended

@susyt I hope you can get your Vitamin D3 up quickly. That is important with Tymlos. I once read that Tymlos "eats D3" so I upped mine to 3,000 units per day and my level stayed stable at 52. Once I finished with Tymlos it started to rise too fast so I went back down to 1,000-2,000 a day.

If full dose is problematic it might be better to lower the dose than stop. My doctor agrees with this and is suggesting this to his patients. For me there was a huge difference between 70mcg and 80mcg, I never tolerated 80 but did okay with 70mcg- but only after backing down to a lower dose and moving up. If you have been on full dose for awhile you might not need to titrate but could just do to 60mcg for awhile.

@drsuefowler it's interesting that your endo has a clinical observation on the differences of side effects for these two anabolics. I've read some publications on various dosing of Forteo. The 20mcg and 40mcg of Forteo were compared in a randomized clinical study. The 40mcg Forteo increased bmd more than 20mcg, however, the 2 doses had similar effects on the risk reduction of fracture. 40mcg seemed more likely to cause side effects. These might be the reasons that 20mcg was marketed. A dose of 56.5mcg once weekly is used in Japan. In their clinical study, the dropout rate for this dose, even once weekly, is high compared to placebo group due to side effects.

Although we can't compare side effects directly between Tymlos vs Forteo, a dose-dependent relationship for side effects may exist. If you are stabalized with 40mcg Tymlos, you might want to titrate upwards like @windyshores suggested to see if tolerable. Thank goodness the pen is adjustable. Otherwise, your endo may have a point.

I took Forteo also with minimum side effect - only fatigue due to low blood pressure for first one and a half months, nothing else. Increased hydration and salty food/liquid helped a lot. Sometime I wonder if the side effects of these two meds are more noticable to those of us who have low blood pressure to start with.

I tried one dose of tymlos at full dose and had the worst migraine in my entire life. I'm very small, history of migraine, and have lower blood pressure to begin with also. I am not sure which of these drugs would be safe for me to try again as it seems I'm very sensitive to changes in factors that influence blood vessel dilation. So is the dose of Forteo equivalent to Tymlos? Dose of what? Is it basically the same drug? Or different enough the doses don't match? I get confused about what to ask for. Evenity was a failure too...I had such bad insomnia i was in tears for weeks.

I tried one dose of tymlos at full dose and had the worst migraine in my entire life. I'm very small, history of migraine, and have lower blood pressure to begin with also. I am not sure which of these drugs would be safe for me to try again as it seems I'm very sensitive to changes in factors that influence blood vessel dilation. So is the dose of Forteo equivalent to Tymlos? Dose of what? Is it basically the same drug? Or different enough the doses don't match? I get confused about what to ask for. Evenity was a failure too...I had such bad insomnia i was in tears for weeks.

I have never had the new Tymlos because I took Forteo back in 2016-2018. What happened to me, (and everyone is different,) is that it wasn’t until after I stopped the drug that I realized how much vomiting it caused. (Forteo is taken daily for 2 years.) I was blinded so to say, because I had another condition at the same time that caused nausea and vomiting.
The nausea was bad enough to necessitate using Scopalamine patches. (Zofran helped but it wasn’t enough.) I had terrible skin breakdown from the Scopalamine no matter where I put it on my body - even my ankle. Towards the end of my treatment, I learned about using ginger chews. (Apparently it helps patients on chemotherapy.)
At my follow- up dexa scan I had 25% increase in BMD in hip, but 14% decrease in wrist. I called the manufacturer and asked how can this be? I was told that drugs can work differently in different body parts.

@genlty I cannot access that link. I thought cortical porosity was a key to flexibilty, but not strength. I have not seen any studies on this idea or the one you cite, and wish I could read it.

I have noticed that treatment, at least with Evenity and Reclast, has made me stiffer, less able to lift or reach w/out pain. I don't recall this effect with Tymlos. It does make me wonder about bone density vs flexibility.