Hi @daisylou , I have a couple of questions. Prior to tymlos, what was your daily total intake of calcium (food source + supplement)? Did you have high calcium level in blood and/or urine (from 24hr urine calcium test) before the start of tymlos?

When I was on forteo, my serum calcium started to rise after 2 weeks to 10.2 from baseline of 9.5ish, then stayed at 10.5mg/dL for 2-3 months before came back down. Forteo ( i think tymlos does the same, but double check) is known to cause temporary calcium increase for a few hours after injection. Coincidentally my initial injections were late evening before bedtime, and blood draws were early am so maybe my results were expected? During second year I switched to am injection (so almost 24 hr post injection), serum calcium stayed mostly around mid 9s with occasional low 10s but within upper normal of 10.4. My endo didn't ask me to do anything differently.

Please let us know your endo's approach to your calcium situation. Thanks.