Which one to choose: Evenity, Tymlos or Forteo?

You can't make a decision based on personal stories. Here you have one person saying Forteo, the other saying Tymlos. Everyone is different. The majority of people do just fine with either one. You won't know until you start.

I'm on Tymlos. One thing I like about it is that it doesn't have to be refrigerated, so it's a lot easier to travel with it as opposed to Forteo.

Ning,
I'm a little wary of pharmaceuticals. I chose Forteo because it is a lower dose of medication 20mcg compared to Tymlos 80mcg.
Forteo has been in use longer than Tymlos which made the research more thorough.
While Forteo is less convenient because it requires refrigeration, Tymlos contains a preservative that some people have allergic reactions to.
Either medication would be a very good choice.

I guess the reason I post is to demonstrate a variety of experiences, not to advocate for a particular choice.

Tymlos was approved April 2017 by the FDA. Forteo in 2002 (generic version 2023). Evenity in 2019.

From Save our Bones:
(Tymlos) activates the same parathyroid hormone pathways as Forteo (teriparatide), and thus functions in the same way. The key difference is that while Forteo is a recombinant human parathyroid hormone analog, Tymlos is a human parathyroid hormone-related peptide analog.

I have wondered whether the difference in mechanism accounts for some of the dosage differences. I liked Tymlos because the dosing is adjustable. I have seen studies that Tymlos is slightly better for spine results. There are comparison charts and the two are pretty similar in results.

@ninglike I have no idea why I could not tolerate Forteo. I went to an immunologist to get desensitized and she basically said my immune system had "gone awry" and that we had failed. My heart sped up, I was out of breath and felt extremely faint, and I had icy stabbing pain in my lungs. Most people don't have this. As I wrote elsewhere I even tried a 10% dose at home (my doctor was amused) by shooting a dose in a sterile cup and using my kid's insulin syringe to draw up 10%. Same problems so not dose dependent. May have been an allergy.

Full dose Tymlos was also tough to handle but I went back on at 20mcg and moved up slowly, eventually staying at 70mcg (full dose is 80). If you don't do a full dose, you do need to refrigerate it so it will last longer, and you need extra needles.

It makes no difference which you choose honestly. Flip a coin! @gently and I are a tag team. She posts Forteo and I post Tymlos, maybe cancelling each other out but letting you know that this decision is not a crucial one in terms of these two drugs.

I really only planned on doing Evenity for the stronger bone-building months (4) and wanted to still have some months left (8) for the future. That said, my doctor was on board because I had some burning sensations that were difficult. I have lupus and high antibodies to scleroderma and have a 20 year history of neuro sensations so this may have been particular to me though a couple of other people have mentioned it. Note I had already done two years Tymlos. Most people do fine on Evenity with few side effects (and tend not to come on forums!).

I only know Evenity. I had no side effects and got a 16 3/4% gain. I saw a cardiologist before starting to be sure he saw no problem. I am 75.

One thing I have not seem anyone mention concerns continuity. I know my track record taking medications on a daily basis - poor. I caught myself missing daily eye drops when I had to use them for more than the normal time after cataract surgery. I am surprised I am still able to take my BP medicine daily. Others seems to be constantly taking one supplement after another throughout the day. I might start out well with Forteo or Tymlos but after a month I doubt if the routine would set in for me. Especially if I had to get a pen out of a refrigerator, let come to room temperature, insert needle, etc etc. Not going to happen. For me, that makes Evenity more appealing.

I did 24 months of Forteo after 13 compression fractures in my spine. I am very grateful for this medication and well worth the initial nausea and tummy bloating. Tried Prolia as follow up, but had jaw and bladder problems so did not continue after initial dose. Went on Evista (Raloxafine) for maintenance for 4 years with no side effects and no breaks. Spine density cannot be done due to previous fractures, but hip was -3.0. It is now -3.5 and recommended to go back on Forteo. After some debate, we decided on Evenity. However, I live in Powell River, BC and seems it requires Parmacare Special Authority first, for which there is at least a two month back log. I have had back spasms recently, which was a pre warning to breaking last time, and my endocrinologist seems unavailable to discuss this with (I think I have annoyed her with my research and questions). So I have decided to put myself back on Forteo for 6 months until Evenity is cleared through Parmacare . (I still have approved prescription for Forteo). Cancer risk vs guarantee that I will break again if I don't do something. Sure wish I had better medical support on this, but seems no one really wants to take on a lost cause.