Hi @bayhorse - Sorry to hear the problems you are going through. While I cannot talk to how each drug might interfere with your current conditions, I can also give my two cents on treating your osteoporosis from a numbers perspective. Since your hip is at -3.4 after two years on Tymlos and you still have a ways to go to get to a lower risk of fracture, Evenity or Prolia do seem to be your best choices at this point. Reclast is not a good choice due to it's lower performance in the hip and it would hinder future drugs like Evenity.

If you are looking to get the best possible performance on bone building in the hip, I would recommend Evenity followed by a long run on Prolia. This would reduce your risk the quickest and the most over time. You would likely stay on Prolia for the rest of your life.

Another route would be just moving to immediately to Prolia and stay on it. This would reduce your exposure to just the one drug.

As for the side effects, both Evenity and Prolia are humanized monoclonal antibodies and are relatively safe. I started on Evenity and moved to Prolia, which I will likely be on for 10+ years. I have not noticed any side effects on either drug, but I am 60 years old without other conditions (for the most part).

I have seen studies on reduced doses on both drugs which just reduce the effectiveness and/or duration of the effectiveness. I'm not sure I would recommend reducing the dosage as these drugs are tricky on the timing of use, especially Prolia.

I put together a training based on all of my research that might be helpful for you. You can find them here youtube.com/@michaellavacot.

Finally, don't wait to transition to some other medication at the end of your Tymlos treatment. You can lose your gains over time without follow-on treatment.

Good luck!