I can't answer your question but I was having side effects for a while and asked my endocrinologist about if the Tymlos was causing it. He told me that the only way to find out was to stop the drug for a week, and then to try going back every other day for a week before going back full throttle again. He didn't seem too concerned about a week off. So I went on a trip in April and also didn't want to deal with worrying about the temp fluctuations, so I was off the Tymlos for 8 days. I have no idea if it messed up any progress I may have had, but I will say that I had a lot more energy that week. I am on my 4th pen, and the fatigue I feel on this drug is getting me down. Not sure I can take another 20 months of this! Plus, I do not have the energy that I once had that could allow me to try to build my bones with exercise, weights, resistance bands , etc. What a conundrum this Osteo journey is.