@osteopatient2026 The 6-8 month point is where my bone markers showed my peak response to Tymlos and that is when I felt the worst!! Are you watching your Vit D too? I noticed that for me if it got too low like 25-35ng/Ml (Vit D, 25-OH) I got shin and wrist pain. If it got too high (above 60ng/Ml) it threw me into hypercalcemia (Vit D was 73 and calcium jumped to 9.8mg/dL) and I got confused, fatigued, and had terrible random bone pain. My Endo said he likes to see Vit D at about 40. Personally I feel best around 40-50 for Vit D and within a tight range either side of 9 for serum calcium. I think it might be worth tracking by journaling how you feel and checking these and adjusting accordingly. Just a suggestion... I think it's crazy they don't mandate checking Vit and D and calcium regularly during this therapy because it is so crucial to the compliance of patients (that is, so many drop out because of these effects) and ultimately to the success of this medicine!