I have been on current dose for 10 months. I started at full dose and had problems. Restarted at two clicks of the pen out of 8 for full dose and moved up to 7 clicks slowly and have stayed there. My doc was happy with 6.

Side effects change over time and get better. I switched to morning which helped, but some prefer bedtime. I had headache, dizziness, heart palpitations all of which got better fairly quickly. I also had fatigue but I was in a cycle where I was less active which made the fatigue worse. Since I picked up my activity level, I am not having any side effects at all.

Depending on my DEXA, I will do either Evenity for further treatment, or a partial dose of Reclast with lots of hydration and tylenol and a slow infusion rate.

Years ago I tried Forteo and could not take it. I even saw an immunologist to try to get on it. I then mistakenly assumed Tymlos would not be possible. Net result was several spinal fractures.

Believe me you don't want those. I would endure significant side effects at this point but fortunately I have not had to. Starting with a low dose and moving up once my body adjusted to that dose really worked for me.

ps My doc has mentioned stopping at one year and "saving" a year for the future. He is great at discussing options with me and letting me choose. I have seen a chart that shows a fairly steep climb in bone density for the first 6 months on Tymlos, a less steep but still significant climb for the second 6 months, and then it starts leveling off a bit.