Forteo vs. Tymlos: Which did you choose?

Interesting and confusing. Based on other comments I have read in this support group and Dr. McCormick's book, Forteo was considered slightly better for the spine. Here's one comment as an example: "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." (I copy and paste various pieces of info from these boards and put it into my osteoporosis Word doc that I am compiling, organized by subject matter, since I could never remember it all.) I just received my copy of Great Bones, and on the chart on page 556, it says 10 to 12 percent approximate increase in spine BMD during first two years and 1.5-2 percent increase for total hip BMD during first two years. For Tymlos, it says 9-10 percent spine BMD during first two years and for hip 2-3 percent. (Copyright 2023).

In the end, it is a moot point for me because my insurance only covers Forteo (actually the generic teriparatide by Alvogen). My hip is only slightly osteoporotic; my main concern is my spine (-3.9 after nearly 4 years of alendronate, same as it was 4 years ago). So I think I would have been happy with either drug, actually, as I am hopeful either would work better for me than alendronate. I'm prepared for results not as great as I would have liked because of having been on alendronate first, but any increase is welcome. Just hoping I don't have any unmanageable side effects (none at all with alendronate). My first dose is this Thursday.

You can find charts that favor the opposite conclusion. I think you are wise to just go ahead especially since you have coverage for Forteo!

I hope the Forteo does the job for you. Honestly, I am very confused at this point. I will go forth with my Rheumatologist plan with the 1 year Tymlos, 1 year Prolia, 1 year Reclast for now. Since I am in my first month with Tymlos I get so much anxiety if I get too far out ahead of myself. Please keep us up to date here with your progress.

Thanks. Hope your plan works for you! Let us know how things go. (My tentative plan is teriparatide, Evenity, then Reclast. Then hopefully a drug holiday.)

To anyone who experienced bloating and belly fat increases from the Tymlos:

Did this side effect go away after treatment? (Were you able to lose the extra belly fat after stopping the Tymlos? )
If so, how did you lose this extra weight? special diet?

@lhankins, I'm curious about why you'll use one year of Tymlos instead of two. Will you use bone markers. Tymlos is a great choice.

@gently My rheumatologist wants me to do one year Tymlos, followed by one year Prolia (terrifies me), followed by one year Reclast (terrifies me more). That’s his protocol. I see him next month and want an alternative plan. As you stated, I would rather stay on Tymlos for two years and then review my options. Even my dentist advised me to stay away from Prolia.

You have to do *something* after Tymlos. You can't just take it and be done with medication, otherwise you will lose the gains you made. The only options are for what to take. It's frustrating, I know.

@lhankins I just lost my long post!

I did Tymlos for two years. DEXA showed dramatic gains at 18 months but bone markers showed it wasn't working at that point. Your doctor may be going by the fact that effectiveness often wanes for the last 6 months or so, and also may be trying to save a year of Tymlos for the future. Curious what they say if you ask!

Dr. Ben Leder in his You Tube video "Combined and Sequential Approaches to Osteoporosis" mentioned the substantial effectiveness of combining Forteo (like Tymlos) and Prolia (minute 11) and, more relevant to you, the substantial effectiveness of sequencing with Prolia after Forteo- ( minute 35 or so). https://www.youtube.com/watch?v=WXoz1NeUgg8

The problem as always is rebound after stopping. Leder says that bisphosphonates can "mitigate" this but the dose, frequency and type of bisphosphonate have not been determined (2022).

I hope you will keep this forum informed about your results. Your doctor sounds creative and as if they are up on research. I would ask about the track record in your doctor's practice of Reclast, for example, after one year of Prolia. People on this forum have cited Keith McCormick (author of "Great Bones") as now being in favor of Prolia for 1-3 shots if followed by a bisphosphonate. My own doctor won't use Prolia unless absolutely the only option but I am wondering if that will change.
ps Leder has another video up that is 6 months old that I just noticed and will watch that!

@njx58 I realize that there needs to be a follow-up to Tymlos and will definitely drill my rheumatologist next month. When I was put on the ‘program’ with Tymlos I did not have nearly the information I have now after following this blog and doing more research on my own. I will post what happens after I go next month.