Tymlos is an anabolic bone building drug so great for increasing your bone density. However, if you don’t follow it up with something to “lock in the gains” you simply go back to losing bone faster than it can be made. Generally it’s followed with a bisphosphonate, in my case we discussed either five years of Fosomac or 3 years of Reclast. I chose three annual Reclast infusions and then I will have a several year drug holiday (bisphosphonates build up in your system). After that is still TBD but osteoporosis is lifelong. I went to my dentist before starting any drugs and asked them to check for anything I might need so I could do so beforehand. My scores were worse than yours however at the age of 51 (spine -3.9 for example). I did gain 20% in spinal bone density thanks to Tymlos so I was pleased with the results and don’t want to lose the gains I had made. I had no issues with my first Reclast infusion. I will have my second in May. Bisphosphonates essentially “coat your bones” so you don’t lose bone as fast. Reclast is the stronger option, Fosomax is a pill taken daily. My mom had severe osteoporosis (broke 16 bones and lost four inches of height due to spinal compression fractures) so I always exercised consistently, ate well, made sure I got plenty of calcium and vitamin D but as my osteoporosis doc noted “genetics are a bitch” so here I am. My sister also started osteo meds at 49. My mom has been on Prolia now for nine years and is doing great. I still ski, do karate, hike, etc. none of the osteo meds are meant to be used long term, so it’s a bit of a long term planning session. My sister wasn’t as severe as me so for her it’s five years of bisphosphonates, several years of drug holiday, then likely back on bisphosphonates for a few more years (like me, her doc will do bone marker testing to determine how long of a holiday by seeing when it’s wearing off for the next step).