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Prescribed Tymlos after Evenity
I completed a one year course of Evenity in September 2023. I switched endocrinologists afterwards, and he prescribed Fosamax after a brief discussion. I contacted the doctor who had prescribed Evenity, and he advised that I come to the office. He prescribed Tymlos, which I have now been on for 8 months. I changed my medical insurance to Medicare, and the doctor who prescribed both Evenity and Tymlos doesn't take it. I went back to the doctor who prescribed Fosamax after Evenity and he freaked out and said Tymlos is NEVER given after Evenity. His colleague in the same office concurred. He then ordered Prolia. I contacted the manufacturers of both Evenity and Tymlos, and they were very considerate and informed me that to their knowledge, there have been no studies about using Tymlos after Evenity. I am currently on a wait list for a new endocrinologist. I have a history of vertebral fractures and I need dental work, and I don't want to be on Prolia. I can finish the remaining months of Tymlos, or switch to Fosamax and wait and see what the new endocrinologist recommends. Needless to say, the situation is not ideal as I'm winging it. That being said, I know that treatment for osteoporosis is complicated and we patients have to be our own advocates and do a lot of research. I'm not opposed to that, but I'm not finding any information for protocols that have a progression of Evenity to Tymlos and then? If anyone has any information to share, I'd really appreciate it.
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Hi @jofall. I have the feeling that you might have missed the entirety of this thread. If you click on the first page and keep going, you'll learn a lot! The members' responses here have been incredibly helpful and informative regarding this sequence of Evenity followed by Tymlos. I, @gently, @mayblin and many others will be highly interested in learning how this sequence works for you as it's quite unusual.
Briefly, I completed one year of Tymlos after Evenity. The original plan was for me to be on Tymlos for two years, but I switched insurance and couldn't find a doctor who would prescribe the second year of Tymlos. (You will find comments on this thread regarding the ideal duration of Tymlos.) My only gain after one year of Tymlos was my TBS improved. I had my first Reclast infusion in May 2025.
Best wishes and warm regards to you moving forward! Do let us know how this has worked for you.
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1 ReactionHi @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.
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