@gravity3
Generally forteo and Tymlos are anabolic…they work by stimulating the thyroid (parathyroid) that is partially responsible for telling the “managers” osteocytes to tell the osteoclasts to get to work building.
Some of these drugs like bisphosonates are just anti reabsorbitives that is they slow or stop the osteoclasts from cleaning old bone thus helping slow or reduce bone loss. Weight bearing excercise done with proper supervision has been shown to help stimulate bone growth without drugs. The issue can be is if your scores are really bad (and we don’t really have a readily available way to test bone strength thst all the doctors and research can agree on like REMS) then we just use DEXA scans. Not really the best but what is used.
So the reason you start with a bone builder is to build the structure of bone and keep the gains with a bisphosphonate …that’s what is called sequencing.
There are different approaches and success depending on you your body Doctor and your diet.
Excercise age…oh so many factors…it’s not as simple as just taking a supplement as some would have you believe…if you have really bad tscores you don’t have the time or risk that someone may have been able to successfully reduce their scores with…everyone’s body is different…
Sounds like you are asking all the right questions or as my professor used to say “there are no dumb questions”❤️
Evenity is newer and works entirely differently…it affects sclerostin and yet allows bone growth while building…that’s better in theory