Prescribed Tymlos after Evenity

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.

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.

@maradeur hi I'm reading about evenity then tymlos? Did u have side effects from tymlos? I'm on evenity not expecting as goid of results as I want my bones to be in because I did 5 years fosamax before evenity read it knocks gains down from 12.7 percent in spine to about 9.5. I want to be on tymlos after evenity but my ins does not cover it it might cover teripartide forto. How do I find an endo quickly that might put me on teripartide after evenity. Tymlos and teripartide forteo are both parathyroid hormone o es same class? Can I just call them tell my situation and see if they would be willing to do it. Before I cancel my mayo clinic endo who will not do it because no studies done on it. I need all the bone i can get. Any advice id appreciate? Thanks. I'm on messenger. Diana nighswonger thanks from nw iowa small town..

@gently hi I'm seeing an endo dr at mayo Rochester mn. I also to want to do tymlos or teripartide after evenity. Been on fosamax 5 tears before evenity chance it will lower my bone gains to 9.5 or something like that versus 13.7 in trials of evenity. So I have screws and rods from fusion. In may 1 2025 at mambo rochester.mn. I want to find an endo that will start me on one teripartide after evenity to gain more bone 2 months after evenity. My current one David Hurley mayo mn won't do it I'm sure he just tell me no studies to show. I DO NOT WANT TO BE ON RECLAST OR FOSAMAX YET. WHERE CAN I FIND AN ENDO I CAN GET INTO WITHIN 4 MONTHS IS ALL I HAVE TILL I WAS TO START RECKAST? Do I just call them talk to them to see if they willing to do that? Help 0lease. I'm running out of time to get this done.

@hollygs holly I am 69 yr old female osteopenia 5 years on fisanax list 2 percent each dexa. On evenity now 7 months. Mayo endo David Hurley wants me to do reclast. I don't want it or proliia. Afraid my evenity not as good as in trials at 12.7 percent. After fisamax it blunts to study said about 9.5. Approx. I want strong bones as have rods and screws from fusion may 1 2025 at mayo l4l5. I want to find an endo who will try me on teripartide prob cuz ins not cover tymlos. But do not want a bispho after evenity. Need more bone built. How do I find an endo in 4 months that will try me on the parathyroid ones after evenity. I have high blood pressure, COPD 30 YEARS OF LUNG PROBLEMS NEVER SMOKED. MOM AND DAD SMOKED BUT I WAS BORN 3 MONTHS PREMATURE HAD LUNG PROBLEMS AND SEVERE ENVIRONMENTAL ALLERGIES WITH ASTHMA AND CGRONIC STUFFY NOSE SYMPTOMS ON NEBULIZER 30 YEARS. SCARED OF RECLAST BREATHING RESP RISKS NOW. WANT TO TRY PARATHYROID ONES AFTER EVENITY. DONT THINK DR HURLEY WILL DO. WILL SAY NO STUDIES WITH THIS SEQUENCE. IM SCARED TO DEATH OF COPD RISKS OF RECKAST AND JAW STUFF IS MORE RISK. CAN U HELP ME FIND AN ENDO AT MAYO WHO MIGHT DO THIS IR AT LEAST TRY, THEN MEASURE MY BONE MARJERS AFTER 4 MONTHS ON PARATHYROID ONE. WILL START it 2 months after evenity to get out of body. Help please. I'm running out of time. I'm on messenger. Diana nighswonger.

Hi @findtheanswersdn. I'm not sure if you read the entire thread regarding my experience with Tymlos after Evenity. I received a lot of excellent information from this community and continue to do so. As I have no affiliation nor experience with the Mayo Clinic, I am not able to help you with your search for a new endo there. When I was looking for a new doctor, I widened my search to "metabolic bone specialist." That enabled me to find a much broader range including rheumatologists and orthopedic surgeons along with endocrinologists. I got very lucky and found an excellent rheumatologist who specializes in osteoporosis, and she video conferenced with me the next day. I had previously seen an orthopedic surgeon who is Chief of the Metabolic Bone Disease Service at HSS in NYC, an endocrinologist and a different rheumatologist.

Your DEXA and TBS after you complete Evenity will be a primary factor in whether or not you should continue building bone. This is not your only opportunity to do so. Continued monitoring of your imaging and bone markers will guide your doctor in their choice of the best medication sequence moving forward. Depending upon what your prior treatment has been, the sequencing can be flexible. It's incumbent upon you to do the research regarding that. It's best to be well-informed prior to any discussion with your doctor. If you disagree with their choices, you will be able make an intelligent rebuttal.

You will find many threads on this site that address your various concerns. I suggest that you do a search for each one separately. You may find a new doctor at the Mayo Clinic here, find new info regarding Forteo, Tymlos, Prolia and Reclast after Evenity (all of which you mentioned) and a lovely, supportive community.

Best wishes to you moving forward.

hollygs, the new chief or the old chief Stein. Thanks.

I saw Dr Lane who is in the department of orthopedic surgery and metabolic bone disease division. (I was originally referred to him as I had severe bone marrow edema in my foot.) He was the one who prescribed Evenity followed by Tymlos.