I've been on Tymlos for about a week. It is somewhat overlapping with the end of my "post Reclast" year. I've had multiple stress fractures/stress injuries in one of my feet. Normally these would be considered biomechanical fractures, but the frequency has led my endocrinologists at Stanford to make the case for fragility fractures and so my insurance approved Tymlos. I had to reduce dose after very strong palpitations on full dose. Thanks to what I had read from @windyshores before starting the Tymlos, I was aware this was an option. One doctor didn't want me to start on a reduced dose. The other thought it was fine. I'm up to 6 clicks and feel okay. Unfortunately now I need a stress test because the palpitations were so strong I had (or thought I had) some pain. But for now on 6 clicks, I have only mild palpitations and basically pass out to sleep soon after the dose, but during the day--I am so tired. My body isn't fatigued like after a vaccination or illness, but I feel like I could sleep and sleep and have very low energy. Has anyone else had this side effect? I don't think I'm having any other side effects so far but I do think I have had increased muscle, joint, bone pain from the Reclast so can't really tell. I'm not sure I can handle being this tired for two years...