Can you take tymlos and prolia

I thought Reclast or, to a lesser extent, an oral bisphosphonate, were the best follow-up drugs after Prolia, and the timing needs to be individualized using the CTX blood test. Can you ask your PCP to order them and consult with another doctor or with Keith McCormick? I have also read that Tymlos isn't useful after Prolia. I would get a second opinion if you can.

Many excellent endo docs don't do those tests so that alone isn't a reason to change. I would be more concerned with the follow-up options you might have. I am getting a second opinion that does use the CTX though!

Where did you find the information that tymlos doesn't work after prolia? I'm not seeing an endocrinologist, can't get appt. I'm in a fracture prevention clinic that has someone who specializes in osteoporosis. Unfortunately my primary care is not very good either. I have been an excellent health until the last few months. So didn't know that I needed these doctors. All the tiny things I I have needed my primary care Was good. Just not for this. I'm trying to change p c p also but live in a rural area and limited options

@burrell5 I may have read that Tymlos isn't effective after Prolia in the book "Great Bones." I tried to look it up and found this, pertaining to Forteo (similar) after Prolia, which is more hopeful:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620731/
" In the prospectively planned DATA-Switch study, we now test the hypothesis that the transition from teriparatide or combined teriparatide/denosumab to denosumab monotherapy and the transition from denosumab to teriparatide monotherapy will further increase BMD in postmenopausal osteoporotic women."

In reference to your question about @windyshores comment about Tymlos after Prolia, I've heard the same though can't remember where. On the prior authorization form for Tymlos provided by my insurance company, it specifically asks whether the patient has received Prolia treatment, when and for how long. It doesn't ask about any other prior treatments. Knowing what I do about how the two drugs work, it stands to reason that Tymlos would likely not be efficatious after recent Prolia treatment. The longer you've been on Prolia, the more this is likely to be the case. Between 5-9 months after stopping Prolia treatment your bone loss resumes, and even accelerates. Sometimes the rate of loss can be more than it was before Prolia treatment. Tymlos stimulates bone growth, and needs to be able to grow bone faster than it's being resorbed. Because ending Prolia treatment can accelerate bone loss, Tymlos may, as a result, be less effective at increasing bone mass.

I was on Prolia for 2 years then started Tymlos in June 2023 after 3 fractures while on Prolia. I don’t know how well the Tymlos is working because my rheumatologist won’t order bone marker tests now but wants to wait for 1 year point. Today I’m going to ask my pcp to order them. Until then I don’t know how effective Tymlos has been so far.

I am assuming the the the rheumatologist said it was ok to go off the prolia to the tymlos. I am trying to educate myself but the more I read the more worried I become. Some articles say the only meds you can't relay off prolia with are bisphosphonates and I have also read not to take bisph with tymlos. Also read tymlos doesn't work well after being on prolia. So confusing and nerve wracking. Please let me know once you get bone markers. My dr refuses to even order them to have a baseline.

Thank you @windyshores. It must have been in Great Bones where I read about Tymlos after Forteo. And thank you for sharing the study. I agree that it's very hopeful, though the combined treatment shown to be the most effective, would be incredibly expensive. Can you imagine what the side-effects could be when taking both at the same time?

In the Interpretation of that study it states, "In postmenopausal osteoporotic women switching from teriparatide to denosumab, BMD continued to increase whereas switching from denosumab to teriparatide results in progressive or transient bone loss."

For anyone who doesn't know about it, or is interested in learning more, this randomized control trial is cited and further explained in the recorded presentation that Dr. Benjamin Leder gave at the Cleveland Clinic about a year ago. The recording which is often referenced in this support group, is titled "Combined and Sequential Approaches to Osteoporosis Therapy". It can be viewed on YouTube.
Here's the link: https://youtu.be/WXoz1NeUgg8?si=Ka8vNnzsjDc9TZXA

It's a bit technical in parts, but well explained and very informative.

Thanks for sharing the video. I literally had to watch it in parts because i got so upset. If this is correct, I am really a lost cause. I am 56. I have been on prolia at least 4 years. I still have 3 months before another prolia injection and now the new supposedly "osteo" dr has put me on tymlos, which is reversed sequence. In 3 months she does not want to renew the prolia. Her plan is for me to stay on tymlos 18 mo then back to the prolia. I am so worried. I feel like I am doomed. I really don't know what direction to go. Prior to 3 months ago, I was extremely athletic, hiking, running, walking, and biking around 200 miles a week. Now I can only do short walks or hikes and strength training exercises.

It would be great if you could get some tests done to see what's happening with your bone turnover to truly know what's happening.

There are still plenty of things that can be done. I didn't mean to scare you.
Learn as much as you can, try to get those tests, and have good discussion with your doctor, or try to find a different doctor. I'm nearly 54. My doctor gave me a Prolia injection last year. I found this group, did a lot of research, decided not to get another Prolia injection, and found a new doctor who is running a ton of tests before I embark on any further treatment.