Prescribed Evenity after 2 years on Tymlos.

Hi @mdm30 , was there any underlying cause(s) for the little improvement after a course of Tymlos?

Here is an important article published just a few months ago regarding anabolic to anabolic sequencing. Could be helpful to some of us:
https://academic.oup.com/jbmrplus/article/8/12/ziae131/7833424
At least one member on this forum did Forteo to Evenity with positive results after little improvement with Forteo. I also came across the rarer Evenity to Forteo/Tymlos sequence and read one person had success, not sure about others.

Please keep us posted!

Mayblin, thank you for posting this article. I did read it and found it very informative. I had hoped that I could find an article/research on similar study with regards to Tymlos (Abaloparatide) to Evenity (Romosozumab).
I'll keep searching....

Agree, we shouldn't extrapolate findings from teriparatide 100% to abaloparatide. In the absence of good reviews on the particular sequence involving abaloparatide that you are looking for, this could be a good reference point as the two drugs act in a similar way although in general abaloparatide affects CTX less than teriparatide. Physicians' clinical experiences and anecdotal evidences could offer a great lead. Please share any information you are gathering and your decision. Best of luck to you!

@mayblin my Dexa scan showed little improvement after 2 yrs tymlos and 1 yr Evenity. Has anyone else had such poor results after three yrs of therapy?
My kidneys/parathyroid blood work has been ok.
Not sure what other factors may be contributing to lack if success. I would welcome any recommendations for additional tests to help understand why I can’t make gain.

@mdm30 Have you been tested for hypercalciuria?

@mdm30
I'm really sorry to hear that you didn't see a response to either Tymlos or Evenity - that must be very frustrating!

A few possibilities come to mind:
- have you had any antiresorptive treatment (bisphosphonate or Prolia) before Tymlos?
- do you have any ongoing medication(s) that affect bones such as corticosteroids, aromatase inhibitors, PPIs (see the medication list in the link), etc.?
- did your dxa scan include spine, hip and femoral neck?

Have you had a full workup to rule out secondary causes of your osteoporosis? Besides vitamin D, calcium and PTH tests, many docs also check for celiac disease or other malabsorption/GI issues, bone mineralization markers such as ALP (this is included in the complete metabolic panel CMP) or bone-specific ALP (BSAP), 24hr urine calcium levels, cortisol test, among others to make sure nothing else is affecting your bones. The following link gives a comprehensive list for secondary causes of osteoporosis, hope it's helpful: https://pmc.ncbi.nlm.nih.gov/articles/PMC5335887/table/t1-ejr-4-1-46/

Curious, were your bone turnover markers tested before and during anabolic treatments? They could give some clues as well.

@mdm30 have you also been doing weight training? I don't think any of the none medications are great on their own. I think the goal is to try to get a better balance of in the bone remodeling process which is out of whack. But I think we need to encourage those cells to get to work by doing the weight training, and then hope the meds get them a little more balanced while they work. Idk if that's true but that's what I tell myself to get me to the gym!

Hello, I am new to the group. I am 71 with a -4.0 on spine. Took fosamax for 3 years because my insurance would not help pay for forteo. Fosamax did not help after 3 years and went on Tymlos for 1 year. Numbers got worse and I ask to stop. Have been off of this for almost two months and my back feel fatigued. My primary Dr. suggested I go on Evenity. Not sure what to do. I have been to an endriocronologist and she could not find an underlying cause for my bone numbers. Not sure about beginning Evenity. If only we had a crystal ball. Sorry you are dealing with this too.

Although Evenity didn’t improve my numbers on Dexa Scsn, most people do have positive results to the Evenity treatment. Took monthly injections for 1 year and I had no side effects.

You’re not missing anything there really isn’t much solid research on the exact sequence of abaloparatide → romosozumab. Most studies look at Evenity either as a first treatment or after antiresorptives (like bisphosphonates or Prolia). There’s very little high-quality data specifically on switching from Tymlos to Evenity, so you’re right to notice that gap. What doctors are likely thinking (based on how the drugs work): Tymlos = purely anabolic (builds bone)
Evenity = dual effect (builds bone + slows breakdown)
So if Tymlos didn’t give much improvement, Evenity is sometimes used as a “next step” to try a stronger or broader effect — even though that exact sequence isn’t well studied.
From what people report (anecdotally), results are mixed — some see additional gains after switching, others don’t see a huge difference. It’s pretty individual. Big picture, the most proven sequence is still: anabolic → antiresorptive. Whereas anabolic → anabolic (like Tymlos → Evenity) is more based on clinical judgment than strong evidence.
So basically:
you’re right, the research is limited
your doctor isn’t doing something totally out of left field
but expectations should probably be “possible benefit, not guaranteed”
If you do go that route, it’s also worth asking what the long-term plan is after Evenity, since that next step is actually more evidence-based.