Anabolic Osteoporosis Drugs

There is a section under womens health re: hrt/bhrt.
If your rheumatologist wants you on evenity and your insurer declines you might ask her/him to write a letter to aetna. Other members will be offering information.

mblatcher, I'd take Tymlos over Evenity because of the way the medications work. Tymlos removes older damaged bone and restores bone that is active. Romosozumab covers the older fissured bone with a heavier less active bone. This Evenity- bone is thick without the canaliculi that enables fluid flow and mechanical signaling that remodels bone according to the stress you life imposes.
Nothing puts think bone on faster than Evenity. If you wanted to take Evenity in spite of the cardiac risks,despite the type of bone it lays down, it would be better to had a stable base of Tymlos-bone first.
Evenity does better than Tymlos only in the heaviness and speed of bone acquisition. I'd take Tymlos for two years and by then we'll know more about a third year of Tymlos and the durability of Evenity-bone as well as the cardiac safety. I wouldn't want to wait and I don't think Evenity is worth waiting for. With Tymlos you won't worry about osteonecrosis or atypical femur fracture. I haven't taken either Tymlos, Evenity or even Prolia.
And I don't have a medical background. Best wishes on your choice.
Saved by the insurance, I'd say.

So sorry you're going through this. I'm in a very similar situation in terms of our ages and osteoporosis profile. My doctor also prescribed Evenity as the very best option for me, but for two months we've been trying unsuccessfully to get the drug approved. My insurance company denied it. We are now in an external appeal process. Perhaps your state has a similar option?

Hello @mblatcher,

Impending insurance uncertainty must be a complicated thing to deal with on top of your osteoporosis diagnosis and weighing which treatments might be best for you. If your rheumatologist thinks Evenity would be best for you due to your age, have you asked them to help you file an appeal with your insurance company on your behalf?

Mayo Clinic Connect is a space where members can share their experiences and to help members gather information to discuss with their providers. Through shared experiences we can help make more informed decisions with our provider's but decisions with powerful medications like osteoporosis meds should always be done in lockstep with your provider. You mentioned should you wait to see what your new insurance plan covers, have you discussed the risks with waiting a few months with your rheumatologist? Are there worries that you may start Tymlos but if your insurance changes you won't be able to finish the full thing if it too is not covered come January 2026?

@gently you sure have done your research! Just curious to know how the body gets rid of the old bone that Tymlos removes …!?

@rashida Your body goes through a constant process of bone remodeling (losing old bone cells and creating new ones.) I've read that most of our skeleton gets replaced every ten years! Bone loss occurs when we're losing more bone cells than are being created.

hi, rashida.
thanks for the question. You'll see I had some fun with it.
The direct answer to the question is that Tymlos doesn't get rid of the old bone. Your blood takes it away. Fragments of that bone are measured in the serum bone marker CTX.
Tymlos does provide the environment that encourages the natural process of renewal in stimulating the development of more active, importantly here, more vascular bone. Because of this vascularity, neither Tymlos or Forteo have warnings of osteonecrosis.

Tymlos increases the calcium levels in our blood, but just for about 4 hours. It pulls calcium from the digestive track, back from the kidneys and even from the bone. That calcium signals that your body is losing bone. While this signals the need for osteoblasts--the cells that build bone. It is the osteoblasts themselves that signal for the cells that dissolve damaged bone.
Extending the question leads to answers about how Tymlos or Forteo increase the cells that dissolve fissured bone.
https://www.google.com/search?q=rankl+video+osteoporosis&oq=rankl+video+osteoporosis&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIHCAEQIRigATIHCAIQIRigATIHCAMQIRigATIHCAQQIRigATIHCAUQIRigATIHCAYQIRiPAtIBCDgyOTFqMGo3qAIAsAIA&sourceid=chrome&ie=UTF-8#fpstate=ive&vld=cid:5c512cd2,vid:Ndn21jtBjR4,st:0
RANKL Receptor activator of NF-κB (nuclear factor-kappa B) ligand
OPG Osteoprotegerin

@gently how are Tymlos and Forteo different? Although in Canada where I am I don’t see that Tymlos is offered yet.

@JustinMcClanahan
I have worked with my rheumatologist to file a total of 4 appeals with Aetna. Each time, the answer was the same- “Evenity cannot be approved because you have not trialed and failed to respond to Prolia”. Very disappointing to say the least. I got my diagnosis on Dec 30 2024. Here I am in October without having made any progress. My rheumatologist was trained by one of the top Osteoporosis docs in the country and I place a lot of trust in her. Unfortunately, she has now left the practice. I will meet her replacement once I start the Tymlos. But who knows who will be in-network come January when my new insurance will kick in. So I might be back to the drawing board. The good news is that whatever insurance I can afford (I’m self insured) should cover Tymlos if I have already begun taking it. I just need to do the training for self-injection, so I should begin pretty soon. The last 10 months have been a roller coaster to say the least!

@brendammc, Forteo is an analog the first 34 DNA segments of parathyroid hormone. Tymlos is a synthetic analog of the first 34 DNA segments of parathyroid hormone related protein. While Forteo is considered biologic in Europe because it is generated from biologic material before manipulation, Tymlos is entirely synthetic.
Tymlos inserts changes in the last 12 segments of the DNA. The processes involved with each are fascinating, but you are probably asking the difference in effect.
Abaloparatide works by binding to and activating PTHR1. The same binding site as Forteo. This binding site has two receptors RO and RG. Tymlos has more affinity to the RG receptor.
Binding to this receptor causes a more transient effect which increases bone building and decreases bone absorption than more than Forteo. Though, Forteo is seen to have more bone building capacity in the spine and Tymlos better in hips.
Tymlos is in an 80mcg dose, Forteo 20. Tymlos is usually only 36% absorbed, Forteo 95%.
Tymlos is less likely to cause hypercalcemia.
Tymlos contains the preservative phenol. Some people are allergic to the phenol. The preservative in Forteo is metacresol. While metacresol protects against microbial growth, it doesn't protect against the breakdown of the drug itself which is highly sensitive to heat. As such Forteo must be refrigerated.
Evidence indicates that the incidents of side effects are greater with Tymlos.
Tymlos isn't available in Canada. In 2021 a marketing agreement was signed, but nothing followed.