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Finishing 2 years of Tymlos this month
Osteoporosis & Bone Health | Last Active: 17 hours ago | Replies (13)Comment receiving replies
@michaellavacot
Regarding the second part of your post:
I think we’re all extrapolating to some degree here, since there isn’t an RCT specifically studying Tymlos ➡️ HRT. All we have is limited data with PTH 1-34 (teriparatide). However, I think we should be careful not to turn an absence of evidence into evidence of absence.
You wrote “ I don’t think HRT is going to keep all of your Tymlos gains” - I agree that we don’t know whether HRT will preserve ALL of the gains. But I don’t think we can conclude that it won’t. Member @teb here has maintained her gains on HRT after Forteo for ~8yrs, although of course that’s anecdotal. I’m on the same general path, and it’s still too early for me to draw conclusions from my own experience. Admittedly, anecdotal evidence is weak. But equally, “I haven’t seen a trial showing this” isn’t evidence that the sequence doesn’t work. There is an RCT that I think is relevant to the question of maintaining gains after PTH(1-34) with HRT:
https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925
I’d be interested in your thoughts on that study.
Regarding “I have seen a study showing HRT + Forteo is better than either one alone” - I’d genuinely like to see that study. I found these two RCTs:
https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925
https://onlinelibrary.wiley.com/doi/10.1359/JBMR.051020
but neither had a PTH(1-34)-alone arm, they do not establish that PTH(1-34) + HRT is better than PTH(1-34) alone. The authors of second paper explicitly acknowledge this limitation. I’m curious what source your statement is based on
And lastly, “if you are going to do HRT, you might want to start now” seems like a separate inference. Even if combination therapy produces greater BMD gains than HRT alone, that doesn’t by itself show that starting HRT before finishing Tymlos improves long-term retention compared with starting it immediately afterward.
Please share the studies that you’ve read. I’m very interested in reading them, and I suspect others here would too.
Replies to "@michaellavacot Regarding the second part of your post: I think we’re all extrapolating to some degree..."
Hi @mayblin - Thanks for the information on maintaining BMD with HRT after Forteo. That is really good news. Perhaps that will hold with Tymlos as well.
As for HRT + teriparatide being better than teriparatide alone, I actually heard that during a training from an HRT expert, I just can't remember which training. And the study I thought showed that, only shows teriparatide + HRT is better than HRT alone. After doing some looking, you're right, there aren't any direct trials showing this, but I did find meta analysis of studies showing HRT + teriparatide gave better results than teriparatide alone https://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2011.02837.x . While I have not purchased the study, here is a CoPilot summary:
"The Spine Benefit: The combination of teriparatide and HRT yields substantial lumbar spine BMD increases depending on the trial and baseline patient characteristics, comparing favorably with standard teriparatide-only averages.
The Hip Benefit: While teriparatide alone has a more gradual impact on cortical bone like the hip, adding it to an antiresorptive like HRT supports total hip and femoral neck density. "
Lastly, when I stated “if you are going to do HRT, you might want to start now”, I was not thinking about BMD retention after stopping, I was thinking about the BMD benefit of adding both together and squeaking out a bit more BMD increase before completing Tymlos.
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@mayblin
really interesting points! I always appreciate your posts. How has your progress been maintaining on HRT after Forteo? Are you using bone markers to monitor? I am finishing up Tymlos next month and have had about a 17% gain! I am pleased considering I could only tolerate a partial dose of 60mg. But unfortunately, I am considered OP. I have also been on HRT and believe that is helping bring my CTX down significantly from baseline (600 down to 175). I am so hesitant to go on a bisphosphonate because of side effects. I am also only 53...so mindful of planning carefully considering the long term. Would love to hear how you and others are hopefully maintaining gains without a bisphosphonate or Prolia.