Finishing 2 years of Tymlos this month

I did RECLAST right after TYMLOS. That was April of this year. So far, so good.
It only took 15 minutes. No problems after the infusion. It will lock in the gains from TYMLOS.

I have a DEXA SCAN coming up in a few weeks and am anxious to see my numbers.
I had major back surgery on April 30th 2026. Bones are strong enough to perform the surgery.
Hoping the RECLAST is doing its job.

There are so many choices out there, so many pros and cons....do what you feel is best for you. You have to be a rocket scientist to figure it all out. But at least we had choices...sadly, our grandmothers didn't.

How long after the end of Tymlos did you start reclast,thanks for your input

Hi there, there are others on this platform that are using HRT as a landing pad coming of anabolics like Tymlos and Forteo. Search for posts by @mayblin. I started HRT 4.5 months before I did my course of Tymlos with great success (my Endo thinks the HRT contributed to this; I was also taking AlgaeCal collagen). My GYN put me on transdermal estradiol to by-pass the liver thus mitigating any potential cardiac issues. This approach is safe and well-documented. If you still have a uterus you would want to also take progesterone (standard HRT Rx is the combo), and then also vaginal estradiol with this. The 3 constitute the 'HRT'. It takes the body a couple of weeks to get used to the hormones again (had slight cramping and heavy feeling) but then it's fine...in fact just great!
I would like to be able to maintain my significant gains made on Tymlos with just HRT but may not be able to and may need to take a bisphosphonate of some kind. We are watching my CTX come down and if it doesn't come down by itself then we might need to force it down with some kind of bisphosphonate. (My Endo's choice is to follow within no more than 8 weeks off the Tymlos with a bisphosphonate.) Whatever you do, maybe think about the HRT as a baseline perhaps? There is a lot out there on it's benefits for menopausal women, even beyond bone maintenance. I would love it if the HRT were enough but even if not, maybe it will let me avoid the stronger antiresorptives and their side effects. Good luck on your journey!

@2024tymloshelp - It's good that you are getting another DXA scan right before you end your Tymlos treatment before deciding. That is the way to do it. While I know you would like some time off on the drugs, if you find that you are still at a very high risk of fracture, you might consider moving straight to Evenity for likely really good results. Here is a link to a recent study showing the performance of Evenity following Forteo https://academic.oup.com/jbmrplus/article/8/12/ziae131/7833424 , which is similar to Tymlos. While it's not the same drug, it is similar so I would expect similar results. Just one option.

I don't think HRT is going to keep all of your Tymlos gains, it sure would be better than nothing. I have not seen any trial on that sequence. I have seen a study showing HRT + Forteo is better than either one alone, so if you are going to do HRT, you might want to start now. Good luck!!!

@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.

@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.

@mdg224
Congratulations on the great improvement! Did you use HRT alongside Tymlos? Could you clarify the time points for your CTX values of 600 and 175, and which drug(s) were involved at each?

My progress from Forteo to 1yr on HRT is shown in the table:
https://connect.mayoclinic.org/discussion/forteo-teriparatide-followed-by-hrt-my-experience/
I had average gains during Forteo and substantial gains during the first year on HRT. However, my P1NP was still elevated when coming off Forteo, and I also used 3 leftover Forteo pens during months 7–11 on HRT, so multiple factors contributed to those gains. Year two on HRT should provide a clearer picture.

Yes, I monitor BTMs periodically along with yearly DXA scans. Because there are no well-established protocols to follow, I prefer knowing my CTX level before each DXA and am also curious whether any correlation exists between CTX and BMD stability. So far, my CTX has remained consistently below 120 during the second year of HRT, and I am due for my next scan in a few weeks. We’ll see what the DXA shows - I’ll share the results in my ‘Forteo followed by HRT’ thread

I’ve talked with my endo about the possibility of using Forteo again if my T-scores/BMD, or FRAX deteriorate significantly in the future. Estrogen could serve as a useful antiresorptive maintenance or transition therapy; the practical details would of course need to be worked out carefully.

I believe the major shift in medical practice after the WHI, and the resulting lack of clinical studies on estrogen for osteoporosis, have significantly limited our understanding of how to use it most effectively. Sharing information and experiences among us is therefore especially valuable.