Unlike Forteo, the Tymlos pen has "clicks" so you can control the dose. Start with two and move gradually up to minimize side effects. Tymlos and Forteo both stimulate parathyroid hormone. In my experience and others', the body adjusts to treatments related to hormones over time, so start low and move up to 7-8 clicks over a couple of months.

I would also comment that the same company that makes Evenity, makes Prolia, so of course they recommend that sequence. My doc will not prescribe Prolia, but low dose Reclast, after I do Tymlos. If my bones aren't good enough after Tymlos I am going to request Evenity then.