Hi @jofall, congratulations on your progress with Evenity!

The sequence (Evenity → Tymlos or Forteo) hasn’t been studied much. I know two people (including @hollygs) who tried one year of Tymlos/Forteo after Evenity without further meaningful gains, but another who stayed on Forteo for two years did improve (though on a different DXA machine), so length of treatment may matter. Tracking bone markers may also help show if the drug is “working".

A couple of Japanese retrospective studies looked at sequencing:
R2T vs T2R: Romosozumab → Teriparatide (1 year on each drug) didn’t add much BMD, while the reverse did show gains. Link here:
https://academic.oup.com/jbmrplus/article/8/12/ziae131/7833424
Romosozumab → bridging drug (bisphosphonate, denosumab, or teriparatide, one year treatment) → 2nd Romosozumab: Re-treatment (of romosozumab) still improved spine BMD, but results varied by bridging drug. Link here:
https://pubmed.ncbi.nlm.nih.gov/39657234/
Neither paper mentioned which dosing regimen of teriparatide was used. In Japan there are a few options: Forteo (20mcg daily) and Teribone (56.5mcg weekly or 28.2mcg twice-weekly) - so the studies may have included different regimens.

Everyone responds differently to medications, but both sequence and time on an anabolic seem to matter - these could be good things to keep in mind and discuss with your doctor as your treatment progresses.

Please keep us updated with your journey.