@gently She doesn't do bone markers, and honestly I forgot to ask specifics about it! She spent about 45 minutes going over all of my options/answering questions & I got lots of info. I took notes, but missed some things. It's at an Osteoporosis Clinic in a research hospital, so super-specialized. She said their infusion clinic is only allowed to do what the FDA recommended dose is, but they do slower infusions, which she said they've seen is helpful. As far as side effects, when I first started Tymlos I had random mild left upper quadrant pain, but not sure if it was from the drug, or that I added Pilates to my 2 day/week training schedule around that time. I always had the rapid heartbeat, but it only lasted a few minutes, and was very mild. I did find the Tymlos patient support helpful when I had questions.

@psmnonna - Yes to Alendronate before Tymlos. When I was first diagnosed I couldn't get into the OP Clinic, and went to a different rheumatologist. He did lots of testing, which I appreciated, but was very old-school in his treatment approach. I was very worried about being 58 and at a "high risk" for fractures so started taking it. It significantly increased the reflux issues I already had, so I stopped it after a few months & didn't go back to him! At my visit yesterday, she really left it up to me to let her know what I want to do about HRT. She knows I want options, so gives me info to let me decide. She said Evista was the safest option with lowest risks & she prescribes it up to age 70. My gyn I saw last month specializes in pre/post menopause and she doesn't think there's much difference in HRT and BHRT - she is a very "by-the-book" doctor (her words!), and that's her opinion. She also said she has patients stay on HRT their entire lives. I've got to figure this part out & let one of them know.