@gently I have never heard that Tymlos "depletes sclerostin." That is important information when thinking about a sequence either way. Can you share a source?

All I know about Tymlos is:
Tymlos (abaloparatide) is a man-made version of a protein related to the human parathyroid hormone (also called parathyrin). Parathyrin is important in bone remodeling where bone tissue is resorbed...

Since Evenity takes time to mineralize (my doc's words) my doctor said I could wait two months (but no longer) before starting Reclast. The same might be true for Tymlos.

We need more research quickly but with Evenity on the market only 5 years or so, it is going to take time. Initially doctors didn't even know that it's anabolic effect was short-lived.

I did Evenity for only 4 months. There are studies I have seen that test doing short bursts of Evenity between other drugs, and also doing Reclast at the 6 month point on Evenity because at that point Evenity, like Reclast, is anti-resorptive.

@hollygs I have not seen or heard of any increase in risk of osteosarcoma with a combination of Tymlos and Evenity, going in either direction. The risk with Tymlos and Forteo has not proven to be valid. Risk of osteosarcoma has not come up with Evenity, to my knowledge. So I am curious why a sequence of these would raise risk- regardless of which comes first.

As for osteonecrosis, Tymlos does not contribute to that since it is not anti-resorptive. Evenity is anti-resorptive for the last months but mildly so. So not sure where that concern comes from either. If you have heard this, I would love any information.