Anabolic Osteoporosis Drugs

So sorry you're going through this. I'm in a very similar situation in terms of our ages and osteoporosis profile. My doctor also prescribed Evenity as the very best option for me, but for two months we've been trying unsuccessfully to get the drug approved. My insurance company denied it. We are now in an external appeal process. Perhaps your state has a similar option?

hi, rashida.
thanks for the question. You'll see I had some fun with it.
The direct answer to the question is that Tymlos doesn't get rid of the old bone. Your blood takes it away. Fragments of that bone are measured in the serum bone marker CTX.
Tymlos does provide the environment that encourages the natural process of renewal in stimulating the development of more active, importantly here, more vascular bone. Because of this vascularity, neither Tymlos or Forteo have warnings of osteonecrosis.

Tymlos increases the calcium levels in our blood, but just for about 4 hours. It pulls calcium from the digestive track, back from the kidneys and even from the bone. That calcium signals that your body is losing bone. While this signals the need for osteoblasts--the cells that build bone. It is the osteoblasts themselves that signal for the cells that dissolve damaged bone.
Extending the question leads to answers about how Tymlos or Forteo increase the cells that dissolve fissured bone.
https://www.google.com/search?q=rankl+video+osteoporosis&oq=rankl+video+osteoporosis&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIHCAEQIRigATIHCAIQIRigATIHCAMQIRigATIHCAQQIRigATIHCAUQIRigATIHCAYQIRiPAtIBCDgyOTFqMGo3qAIAsAIA&sourceid=chrome&ie=UTF-8#fpstate=ive&vld=cid:5c512cd2,vid:Ndn21jtBjR4,st:0
RANKL Receptor activator of NF-κB (nuclear factor-kappa B) ligand
OPG Osteoprotegerin

@brendammc, Forteo is an analog the first 34 DNA segments of parathyroid hormone. Tymlos is a synthetic analog of the first 34 DNA segments of parathyroid hormone related protein. While Forteo is considered biologic in Europe because it is generated from biologic material before manipulation, Tymlos is entirely synthetic.
Tymlos inserts changes in the last 12 segments of the DNA. The processes involved with each are fascinating, but you are probably asking the difference in effect.
Abaloparatide works by binding to and activating PTHR1. The same binding site as Forteo. This binding site has two receptors RO and RG. Tymlos has more affinity to the RG receptor.
Binding to this receptor causes a more transient effect which increases bone building and decreases bone absorption than more than Forteo. Though, Forteo is seen to have more bone building capacity in the spine and Tymlos better in hips.
Tymlos is in an 80mcg dose, Forteo 20. Tymlos is usually only 36% absorbed, Forteo 95%.
Tymlos is less likely to cause hypercalcemia.
Tymlos contains the preservative phenol. Some people are allergic to the phenol. The preservative in Forteo is metacresol. While metacresol protects against microbial growth, it doesn't protect against the breakdown of the drug itself which is highly sensitive to heat. As such Forteo must be refrigerated.
Evidence indicates that the incidents of side effects are greater with Tymlos.
Tymlos isn't available in Canada. In 2021 a marketing agreement was signed, but nothing followed.

@brendammc, Forteo is an analog the first 34 DNA segments of parathyroid hormone. Tymlos is a synthetic analog of the first 34 DNA segments of parathyroid hormone related protein. While Forteo is considered biologic in Europe because it is generated from biologic material before manipulation, Tymlos is entirely synthetic.
Tymlos inserts changes in the last 12 segments of the DNA. The processes involved with each are fascinating, but you are probably asking the difference in effect.
Abaloparatide works by binding to and activating PTHR1. The same binding site as Forteo. This binding site has two receptors RO and RG. Tymlos has more affinity to the RG receptor.
Binding to this receptor causes a more transient effect which increases bone building and decreases bone absorption than more than Forteo. Though, Forteo is seen to have more bone building capacity in the spine and Tymlos better in hips.
Tymlos is in an 80mcg dose, Forteo 20. Tymlos is usually only 36% absorbed, Forteo 95%.
Tymlos is less likely to cause hypercalcemia.
Tymlos contains the preservative phenol. Some people are allergic to the phenol. The preservative in Forteo is metacresol. While metacresol protects against microbial growth, it doesn't protect against the breakdown of the drug itself which is highly sensitive to heat. As such Forteo must be refrigerated.
Evidence indicates that the incidents of side effects are greater with Tymlos.
Tymlos isn't available in Canada. In 2021 a marketing agreement was signed, but nothing followed.

@brendammc, Forteo is an analog the first 34 DNA segments of parathyroid hormone. Tymlos is a synthetic analog of the first 34 DNA segments of parathyroid hormone related protein. While Forteo is considered biologic in Europe because it is generated from biologic material before manipulation, Tymlos is entirely synthetic.
Tymlos inserts changes in the last 12 segments of the DNA. The processes involved with each are fascinating, but you are probably asking the difference in effect.
Abaloparatide works by binding to and activating PTHR1. The same binding site as Forteo. This binding site has two receptors RO and RG. Tymlos has more affinity to the RG receptor.
Binding to this receptor causes a more transient effect which increases bone building and decreases bone absorption than more than Forteo. Though, Forteo is seen to have more bone building capacity in the spine and Tymlos better in hips.
Tymlos is in an 80mcg dose, Forteo 20. Tymlos is usually only 36% absorbed, Forteo 95%.
Tymlos is less likely to cause hypercalcemia.
Tymlos contains the preservative phenol. Some people are allergic to the phenol. The preservative in Forteo is metacresol. While metacresol protects against microbial growth, it doesn't protect against the breakdown of the drug itself which is highly sensitive to heat. As such Forteo must be refrigerated.
Evidence indicates that the incidents of side effects are greater with Tymlos.
Tymlos isn't available in Canada. In 2021 a marketing agreement was signed, but nothing followed.

@gently thank you for such good information. I just finished reading a study and see that there are CV risks with both. Since I have PCA narrowing moderate to severe, now I’m questioning what’s best.I had read earlier that Evenity was not recommended for that reason but also just read that it wasn’t any worse than the other two.
So much info out there. I’m just trying to find out as much as I can before seeing my specialist next month.
I hope you appreciate how much your info helps.

rashida, it was supposed to lead you to this video The RANKL/RANK/OPG system in bone
YouTube The Histology Wizard Jan 17, 2022
Which answers what I thought was your question. Then even though it isn't the answer you asked for, I sent it.
Personally, I think Forteo is the better medication. Unreasonably. Except it is more biologic, though there isn't any comfort in what it is extracted from. It is (said to be) more effective in the spine. Spinal fractures are my greatest fear. I'd prefer a hip fracture over a spinal fracture.
But I wasn't trying to say that. I was trying to be neutral.
Tymlos works better in the hips. It is less likely to cause hypercalcemia because of the more transient elevation of calcium. I've read that it is a little less likely to cause nausea and/or dizziness. I do like the downside of refrigeration with Forteo, since that is why it doesn't need phenol as a preservative. I'm happy that Forteo is 20mcg and not 80mcg. Even though (and even since) absorption makes it 28,8 for Tymlos and 19mcg for Forteo.
You really do have to question everything I say. I really am a one trick pony.

mblatcher, I'd take Tymlos over Evenity because of the way the medications work. Tymlos removes older damaged bone and restores bone that is active. Romosozumab covers the older fissured bone with a heavier less active bone. This Evenity- bone is thick without the canaliculi that enables fluid flow and mechanical signaling that remodels bone according to the stress you life imposes.
Nothing puts think bone on faster than Evenity. If you wanted to take Evenity in spite of the cardiac risks,despite the type of bone it lays down, it would be better to had a stable base of Tymlos-bone first.
Evenity does better than Tymlos only in the heaviness and speed of bone acquisition. I'd take Tymlos for two years and by then we'll know more about a third year of Tymlos and the durability of Evenity-bone as well as the cardiac safety. I wouldn't want to wait and I don't think Evenity is worth waiting for. With Tymlos you won't worry about osteonecrosis or atypical femur fracture. I haven't taken either Tymlos, Evenity or even Prolia.
And I don't have a medical background. Best wishes on your choice.
Saved by the insurance, I'd say.

@JustinMcClanahan
I have worked with my rheumatologist to file a total of 4 appeals with Aetna. Each time, the answer was the same- “Evenity cannot be approved because you have not trialed and failed to respond to Prolia”. Very disappointing to say the least. I got my diagnosis on Dec 30 2024. Here I am in October without having made any progress. My rheumatologist was trained by one of the top Osteoporosis docs in the country and I place a lot of trust in her. Unfortunately, she has now left the practice. I will meet her replacement once I start the Tymlos. But who knows who will be in-network come January when my new insurance will kick in. So I might be back to the drawing board. The good news is that whatever insurance I can afford (I’m self insured) should cover Tymlos if I have already begun taking it. I just need to do the training for self-injection, so I should begin pretty soon. The last 10 months have been a roller coaster to say the least!