@lucifrancis I also have the significsnt lower body bone pain and had to reduce from 80 mcg to 40 mcg. Despite my determined effort to titrate back up by 10 mcg every 10 days to 80 mcg, I was stopped in my tracks by unbearable pain at 60 mcg and was not able to hold there or even at the 50 mcg. I quickly had to return to 40 mcg (now for 3 months) and still occassionally struggle. I have maintained a strong response per P1NP and CTX markers. Also, I had switched to PM injections to help mitigate the headaches and nausea, but I quickly learned the PM injections for me increased the lower body bone pain and interfered with sleep terribly, so I switched back to AM. The daytime movement seems to help. I have my first DEXA, since starting treatment (two failed, due to side effects.....and currently on Tymlos for 4 months) in late August.