@kaa1 jaw necrosis is pretty rare, according to my doctor and online sources, and the recommendation is to use Reclast for no more than 3-5 years to avoid it and atypical femur fracture. Cancer patients on high doses and people with certain preexisting dental issues are apparently more at risk.

Are you saying your bone density got worse on Tymlos? Are you going by the DEXA? If, say, -2.5 becomes -2.1 that is an improvement. Did your score go up or down?

So you have to stop Tymlos? Did your spine or hip improve? Forearm is mainly cortical (as is the hip) and Tymlos is best for trabecular bone (spine). So many of us have dramatic gains in spine but not in cortical sites. How is your spine?

Your options after Tymlos are a bisphosphonate (oral or infused) and, possibly, Evenity (my doctor says there is no data on this but I did do it after Tymlos, and many on this forum are).

No matter what you do, Reclast or possibly Fosamax would be needed to lock in gains. Many of the people I know do really well on Reclast in terms of side effects, but the people who post tend to be having side effects. You need to hydrate well and can ask for an hour long infusion. First time, something like 40% have an "acute phase reaction" with fluish symptoms and even fever but that only lasts a short time. It tends to happen only the first time, and that is what happened with me.

Here is an interesting piece of info on CTX and bisphosphonates: I am trying to use CTX to minimize my infusions...

"It measures the C-terminal telopeptide (CTX) value, which depicts the level of octapeptide fragment released due to osteoclastic bone resorption from type I bone collagen.[36] Its levels are related to the number of osteonecrotic lesions, stage of disease, and bone turnover index.[37] A lower value represents a high-risk patient with suppressed bone turnover and reduced healing capacity. C-terminal telopeptide less than 100 pg/ml equals high risk, 100 to 150 pg/ml equals moderate risk, and greater than 150 pg/ml equals minimal or no risk."