I was on Tymlos 2 years with severe Osteo with 8 foot fractures. Tymlos did a great job on my spine ( mostly trabecular bone) but reduced cortical strength in my feet to the point they were severely vulnerable. I was put on actonel which reduced CtX from 400’s to 83 in less than 6 weeks ; at the same time my p1np plummeted too.
I needed more anabolic support so went on Evenity. I feel it is working well and will also hrlp cortical bone