Hi @2024tymloshelp,

Were you on any anitresorptives (like bisphosphonates, prolia, estrogen or evista) prior to tymlos treatment? Are you using HRT currently with tymlos?

Many members here do see bmd improvements on tymlos after the first year, especially in the lumbar spine. I'm sure there are exceptions. Hip and femur neck changes usually take longer.

The best time to see btm (bone turnover markers) response to tymlos is during first 1-6 months, but it won't hurt to check now. Doing both CTX and P1NP could give you better information, especially if the results come back very high or very low since you won't have a trend of change. In case you can't get lab orders from your doctor, you can self order (and self pay). The best price I've seen for btm is through JasonHealth website.

Typically, while on a PTH analog like tymlos or forteo, bmd doesn't decrease. I think its reasonable to continue another 6-12mo while aslo planning the next phase of treatment. Some people who don't respond to tymlos/forteo transition to Evenity and see successful bmd gains. In your situation, I wouldn't transition to an antiresorptive at this stage.

It's important to ask your doctor to rule out secondary causes for bone loss (parathyroid, thyroid, GI malabsorption, certain meds etc), which could explain the lack of bone gain while on an anabolic.