Prescribed Tymlos after Evenity

Posted by hollygs @hollygs, Nov 17, 2024

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.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

Thx…did you do anything special? Sure appreciate your input and experience with Tymlos.

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Profile picture for osteopatient2026 @osteopatient2026

Thx…did you do anything special? Sure appreciate your input and experience with Tymlos.

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@osteopatient2026 Thank you for the kind words. I think the best thing I did was joining this community. I have learned so much and have felt so supported. I also learned that I prefer to focus on the positive and eliminate stress as much as possible. Most people come here because they are seeking answers for issues they experience. There's a whole other side to explore, which is to also search for positive experiences people have had. That feels more balanced to me. It's human nature to try to anticipate what could go wrong, but it's also possible to anticipate what could go right. I hope that makes sense!

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Profile picture for osteopatient2026 @osteopatient2026

What if any side effect did you have from Tymlos when you started? I’ve been on it 10 days woke up feeling a bit nauseous last night but it went away.
Have a little bit this afternoon but now I’m anxious

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@osteopatient2026
No side effects, but I started with small dose (2 clicks);
and worked my way up to full dose over several weeks

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You are so right that we have to be our own advocates!!! I have gained alot of knowledge and insight from reading this blog, the AlgaeCal Community page and the individual drug support groups (ie. Fosamax, Evenity, Reclast and Tymlyos, Prolia) on Facebook. I also found a ton of info in Kieth McCormicks book "Great Bones". Hope this helps some. Best wishes on your bone journey.

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Profile picture for mcallister1002 @mcallister1002

You are so right that we have to be our own advocates!!! I have gained alot of knowledge and insight from reading this blog, the AlgaeCal Community page and the individual drug support groups (ie. Fosamax, Evenity, Reclast and Tymlyos, Prolia) on Facebook. I also found a ton of info in Kieth McCormicks book "Great Bones". Hope this helps some. Best wishes on your bone journey.

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@mcallister1002 Thank you - those are invaluable resources! I'm so glad you've taken the initiative to advocate for yourself and are finding it worthwhile. Best wishes to you moving forward!

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Profile picture for sunny65 @sunny65

Hi @windyshores , this is exact conversation I was looking for. I been struggling with my back pain for over 7 months now. I am on Evenity. Two doctors suggested Tymlos after and information is very conflicting. It’s not much research done on the subject. I been finding various answers- from yes, you can go on Tymlos after Evenity with 2 months break in between. I also found information that no need to wait 2 months- just one. All this is very confusing. My endocrinologist didn’t respond to my email where I asked him very same question. I am not sure if my pain is from Evenity or from old fractures, posture and very weak bones. I probably have to finish Evenity. I hate not be able to move so much. I still trying to do a few exercises and eat food loaded with calcium and taking vitamin D , magnesium. My husband bought treadmill for the home since he is not able to walk with me everyday. I will start walking more everyday. I installed an app curable health but not sure if this is going help me because pain is none stop, except for a 2-3 hours in the morning. I would like to read someone’s experience who doing or did Tymlos after Evenity . I don’t have a lot of choices with my -5.1 T score. I have to build bone first in order to move on any other medication which supports what already build. ( sorry for mistakes - I am writing through the sever pain).

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@sunny65 hi I'm on evenity months 10. Need to be on bone builder yet because I had to have fusion 7 months ago. Don't want to be without a real bone builder in my next year of healing tobacco full fusion success. So I want teripartide does any one know of any endocrinologist who made do that for me. I have multiple other conditions and lots of teeth not in my mouth whi h put me at greater risk from bisphosphenates fir jaw necrosis and atypical fractures hips are lower than spine now and need teripartide. Got 3 months till end jan to figure this out. Mayo clinic wants reclast iv im scared to death can't get it out body once in there. Top many severe risks with that in my fusion new state I feel. I am in no pain now after fusion AND DONT WANT ANY RISK TO PAIN THATS NOT REVERSIBLE. LONG TERM PAINS ETC IF I GET FROM IV BISPH THEY ARENT LEAVING THEN IM IN PAIN REST OF MY LIFE. NO THANKS. DONT WANT A LIFE OF PAIN PILLS TO RUIN KIDNEY AND LIVER THAT DO NOT HELP. I DONT CARE IF I HAVE TO DRIVE TO FIND HIM OR TELEHEALTH VISIT. ANYONE NO PF ONE WHO DO THIS FOR ME. WTMRISTS ARE STILL - 2.2 AFTER 11 MONRHS EVENITY. HELP PLEASE IM RUNNING OUT TIME AFTER LAST SHOT EVENITY JAN. ONLY HAVE MONTH THEN NEED START SOMETHING ELSE DONT WANT BISPHOS. I want goid solid new bone for 2 more years then ill have to do bisphos.

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Profile picture for sunny65 @sunny65

Hi @windyshores ,
Actually , my endocrinologist called me today. He is concerned to stop Evenity now because insurance might cancel coverage on Evenity and then don’t approve Tymlos, because they both anabolic . He still insists that my increased pain is due to fractures not a side effect of Evenity. I am thinking to call insurance and ask if they would approve Tymlos in the middle of my treatment. Besides he worries that insurance might not approve Tymlos even I finish all 12 months of Evenity for the same reason. He said that I might have to go on Prolia after Evenity which I completely was against but again he stated that Prolia rarely causes back pain. Not sure if our conversation was that productive . I am going for my MRI next week and if there are no new fractures, I am going to call him back and maybe ask again. All I know that pain I am going through is not sustainable for a long time and something needs to be done.

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@sunny65 all these dr worry is oh your ins wont cover. DOBTHEY NOT KNOW THAT THEY HAVE THE POWER TO TRY TO GET ANOTHER TREATMENT NOT SO WELL KNOWN FOR US BUT THEY HAVE TO WRITE INS OR FAX OR CALL THEN TO REQUEST OTHER COVERAGE BECAUSE 1. WE ARE STILL HIGH RISK AND TELL THEM WHY. 2. ONE TREATMENT DIES NOT FIT ALL AND EVERYONE HAS DIFFERENT CONDITIONS THAT CAN PUT US AT MORE RISK TO A DRUGS SIDE EFFECTS AND THEY NEED TO RECOGNIZE THAT. THEY CANT PUT US ALL IN SAME BOX AND JUST COOKIE CUTTER OUR TREATMENT TO SAME ALL THE TIME BECAUSE THEY ARE TOO LAZY TO DO SOME LEG WIRK TO GET SOMETHING ELSE APPROVED. THATS WHAT PRIOR AUTHORIZATION IS FIR. THEY ARE JUST LAZY. IGNORE STUDIES OF REAL WORLD AFTER MARKET STUDIES SAYING NECROSIS OF JAW IS MORE PREVALENT IN REAL WORLD FINNISH STUDY ON PUB MED. UP TO 6 TIMES HIGHER IN LOW DOSE BISPH AS RECKAST AND ALENDRONATE THAN THEY SAY IN FURST CLINICAL TRIAL APPROVAL FDA ONE. AND GOES FOR ATYPICAL FRACTURE AND SEVERE BONE JOINT BACK PAINS LONG TERM TOO. MORE RISK THAN SAY. ALSO I READ AMERICAN DENTAL ASSOC SAYS DR IGNORE THEM. WHEN THEY SAY RISK TO JAW IS AKSO MORE IN PATIRNTS WHO HAVE HAD LOT OF TEETH PULLED; ME 5 OR 6 IN LIFETIME MORE RISK NOT JUST RECENT PULLS BECAUSE MORE JAWBONE IS EMPTY OF TEETH MORE VULNERABLE. IM SCARED. I NEED ENDO OR RHEUMTOLOGIST TO GIVE ME CHANCE ON TERIPARTIDE 2 TEARS IT WILL BRING MY BMD UP IN THOSE 2 YEARS MAY INITIALLY FALL A BIT IN ANABOLIC WINDOW BUT AFTER MORE BISPH IT WILL BE ONLY HALF. HELP ANYONE.

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Profile picture for sunny65 @sunny65

Hello @hollygs . Thank you so much for your kindness and reply. Yes, I am in a very tough situation. Never expected nothing like this. I been working with pain specialist and he tried a few things which all failed and made me worse. My pain is none stop and all my medical team don’t offer anything but Tramadol and now Norco ( I didn’t take this yet). But Tramadol doesn’t work anymore. I never took anything like this before and it makes my stomach very upset. My hands are shaking and I really don’t know where this all is going. My endocrinologist told me that I can start Tymlos right after finishing Evenity. I was looking for information everywhere and not much studies done. The most doctors offering the opposite. Tymlos and then Evenity. I been searching if anyone in this group has any experience with this kind of sequence. Thanks God you wrote to me. My -5.1 T score is very scary. Please tell me how soon you started Tymlos after Evenity and what was the outcome. It is very hard to live with this pain. I was very active and outgoing and for the past 7 months I stopped going anywhere except doctor’s appointments and this is very sad and depressing. Thanks again for any advice and input.

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@sunny65 where who can give me teripartide after evenity? Im desperate to find someone somewhere by end jan or first feb. I live in nw Iowa right now im at mayo Rochester mn. They won't do it.

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Profile picture for awfultruth @awfultruth

@hollygs Reading thru your post and all the comments I don't see anything about bone scans. Are you getting DXAs or Echolight scans to track what results you are getting with the different meds?
If you are getting scans and have one at beginning and end of Evenity and one at the beginning of Tymlos (I guess that's the same as the end of Evenity?) then you can get another scan now and know exactly how you are doing on Tymlos. There's no absolute magic about waiting a year (other than insurance and money) for a scan. I've twice paid for DXAs rather than waiting till the year was up, because I wanted the information right away to make decisions about what I'm doing with my osteo treatment.

Others have given you good info on your situation. I agree that there is currently no research to show what happens following Evenity with Tymlos.
I could not find any. My guess is that it would work. But that is nothing but a guess.
A few months ago when I was researching this I was interested in following that sequence myself. I gave it up because I just couldn't find any evidence to support that path. I thought it likely that it would work but I did not want to chose a sequence with no evidence supporting it.

I searched the various osteoporosis forums trying to find people who were following Evenity with Tymlos or Forteo. I found 3-4 people who were doing or about to do that on their doctors recommendation. No one had completed a year on the follow up med and none had a scan yet to see the results.
I found an interview where Dr Michael Lewiecki a noted osteo doctor, mentioned that he had had one patient do that with success. He gave no further relevant details on that one case.
So if you have a baseline DXA scans and you get another DXA you may be our first test case. I'm guessing and hoping you will be successful.

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@awfultruth I feel its has a better chance to work better than any antiresorptive out there with exception of prolia but I have too many of their side effects listed to want to make them worse by trying that one until I have 1 foot in grave and be 87 years old. Im only 69. Too much life I want to be pain free to risk bisphos YET. WANT BONES STRONG THEY CAN POSSIBLY BE. WRISTS STILL -2.2 ON ALMOST YEAR OF EVENITY. I DONT CALL THAT HOID. HIP IMPROVED ONLY -0.4 TO - 0 3 . NOT GOOD ENOUGH FOR ME. I too got
Self pay dexa. I have bone on bone hips no cartilage on top poor bone score. Scared as he'll I am. Bout screws loose from hardware and jaw and hip frx from bisph.

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Profile picture for hollygs @hollygs

@awfultruth Thank you for your reply. I agree with your points. I too have grave concerns in regards to Prolia. The concern in regards to Tymlos before or after Evenity is that you may start to produce abnormal bone. Tbh, the timing of introducing certain new medications seems to be lacking standard protocols and is up to the doctor's discretion. In my case, I'll do a DTX and TBS after I complete the first year of Tymlos. And in regards to Fosamax and dental work, that endo believes that you have to be off it for any dental work and that's unreasonable. Luckily, I have found a new metabolic bone specialist.

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@hollygs who if I may ask is your new metabolic bone specialist? Im looking for one ASAP to see if I can do teripartide after evenity. It's an antiresorptive fir last 7 months anyway so if I wait one half then do teripartide anabolic window should be gone and no problem. Wrist on dexa bad -2.2 [
On 11 months of evenity. Not hoid in my book hips improved tenth of a point. -0.4 TO - 0.3 AND ALL THEVARTHRUTIS I HAVEVAND BONE SPURS STARTINF OF RETROLISTHESIS SLIPPED DISCS IN L1 L2 L3 AND C5 C6 AND C6 AND C7. AND T12 TO L1. IM IN TROUBLE FOR FUTURE AND NEED STRONG AS BONES AS I CAN GET. HIPS ALSO BOTH NO CARTILAGE LEFT. IM ONLY 69 NOT READY FOR ALL THIS DEBILITATING STIFF. I WANT TO GO TO FLORIDA SECOND HONEYMOON AND CAMPING AND FISHING WITHOUT WIRRY OF PAIN AND JAW AND BROKEN ATYPICAL FRX FROM BISPHOS YET. NEED 2 YEARS TERIPARTIDE INS COVERS NOW NOT LIKE LAST YEAR OF MY FUSION IN MAY 2025.. ANYONE ONE KNOW OF PHYSICIAN IN IOWA OR MINN OR SOUTH DAKOTA OR NEBRASKA THAT WOULD START ME ON TERIPARTIDE . HIGH RISK CUZ RODS SCREWS FROM FUSION AND LOW BONE STATUS FAILED TO KEEP GAINS ON FOSAMAX 10 YEARS PAST TOO PLUS ALL OTHER RISKS OF BISPHOS.help if i know of someone

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