Osteo Meds are 2 distinctly different classes; this is important. Here ( below is a paragraph from that article) in a nutshell is a great deifinition from : Skeletal responses to romosozumab after 12 months of denosumab - PMC
Please pay particular attention to the last sentance about sequencing. Bone forming drugs are not as effective ( but still work to some degree) if taken after bisphosphantes.
----------------------------------------------
".....Antiresorptive drugs and bone‐forming agents are distinct classes of therapies for treating patients with osteoporosis.( 1 ) Estrogen receptor activators, bisphosphonates, and denosumab are anti‐remodeling drugs that reduce bone resorption and formation, increase bone mineral density (BMD), improve bone strength and reduce fracture risk, but they do not restore the disordered trabecular microarchitecture found in patients with postmenopausal osteoporosis.( 2 ) In contrast, bone‐forming agents stimulate bone formation, resulting in large increases in BMD and improved bone structure, and have been shown to be more effective at reducing fracture risk than oral bisphosphonates.( 3 , 4 , 5 , 6 , 7 ) Based on these data, bone forming agents are recommended as appropriate initial treatment for patients at very high risk of fracture.(..."
This should help you identify what is best for you based on your fragility state.
Now that said, bone forming drugs have unique charatieristics. Forteo and Tymlos build mostly trabecular bone and can in some cases ( my case) decrease cortical bone. Spine is mostly trabecular bone so if you are more concernered with spine issues, then either of those could be considered. I persoanlly had mutilple fractures in my feet which is mostly cortical bone. Therefore for my situation, Evenity is being used after tymlos to rebuild cortical bone. Hope this helps. Meanwhile I advise you read Great Bones by McCormick for further infomration to help identify cause for the osteo and help support your recovery. ( In my case I had super high urine cal lost, high homocysteine, high vitamin D,- also i had to stop drinking softened water which was processed with salt which compounded bone loss- all of these had to be brought into balance to effectively allow the drugs to work. I had corrected my diet and sleep schedule also. Low sugar no caffeine, low acid foods no alcohol lots of veggies ) Sending postive energy for your research, decsiison and recovery. You can do it!! God bless.
dmshope: Great post. Thank you for sharing your information. I did not know about trabecular versus cortical bone. But, that would explain why when I told my endocrinologist I wanted to get off of denosumab and go on Forteo, for the 2nd time, (it has been 15 years since I last took it) she said Forteo only worked for the spine and my Dexa showed my spine had improved to osteopenia, but my hips were full on osteoporosis and Forteo didn't work for hips.
My current dilemma is I have been on Prolia for 5 years and did fine. Then the endocrinologist, under the mandate from the health care organization she works for, switched me to a biosimilar drug for Prolia (Jubbonti-only on the market for 3 months) I'm sure their was a monetary incentive for them in some way, and I have been miserable with side effects since my injection 5 weeks ago. That was why I had a conversation with endo. asking to go back on Forteo. I have told her that if she can get an exception from Sutter Health, the organization she works for, to let me go back on Prolia rather than Jubbonti, I will try it once again. Now, if I have another bad reaction after a Prolia shot in 6 months I will then assume my body, after 5 years, has just decided that it doesn't appreciate denosumab, in either formulation whether it be Prolia or Jubbonti. Then I'm going to be throwing my hands up in the air trying to figure out what to do.