After 20 months on Tymlos

Have you and your doctor discussed what's next? I would start soon on a follow-up. Depends on what your DEXA says. If you've made a lot of progress, you can take Fosamax or Reclast. If you still need more bone-building, you could do Evenity for a year, and then follow that up.

hi, poppydog. You should transition to the next drugs within a couple of weeks after stopping Tymlos. Some doctors prefer to wait a month. The most common after Tymlos drug is Reclast. It is good to look at side effects before deciding which medication to follow. I like the idea of Evenity after Tymlos, and some people have gains with this sequence. I don't think it is mainstream though and your doctor may not be willing to prescribe.
I'm on Forteo and if I had to transition it would be to an oral bisphosphonate, probably risedronate because it doesn't adhere as long to the bone as alendronate or Reclast.
I'd be a little wary of Reclast because of the side effects some suffer. It seems to be more often a negative encounter for those with autoimmune disease.
You'll most likely be offered Reclast or Prolia. I'm wary of Prolia mainly because of rebound.
Will you be having bone markers?
I might consider Zometa because it is a lower dose than Reclast. But I'm always be looking for a path back to Forteo.