Do we know the effects of Forteo & Tymlos on the femoral neck?

I just read that the femur neck is 80% cortical, and the interior of that bone is trabecular, comprising 20%. I asked my doctor about whether Tymlos had a negative or zero effect on cortical bone (porosity), like Forteo, and was told that with Tymlos, the effect on this cortical bone was not a problem. It does improve the spine the most (trabecular) but Tymlos is okay for femur neck. Evenity might have a stronger positive effect on cortical bone in the femur neck (also in forearm). But ask your doctor!

My dr. said that with Tymlos or Forteo, I might actually see a decrease on Dexa in femoral neck which I would not like to see. He said eventually he thinks it would go up, but that the studies weren’t done for long enough to prove that, So, I stay on the fence and am doing hormones, which positively impact all bones, but maybe not significantly enough. My scores are the same as yours, but I did have a lumbar fracture and needed Kyphoplasty to repair and stop pain.

Doesn’t Tymlos insert mention it might increase cortical porosity?

During the Bone Health Summit 2.0 last month, Dr Keith McCormick did an interview titled Osteoporosis Medication and an Integrative approach to Treatment. In the interview when asked about Forteo and Tymlos, he said that, as @windyshores pointed out, the femoral neck is mostly cortical bone. I think he said that the spine is 40% cortical, and the total hip (not the femoral neck alone) is 50% cortical, and the total hip usually does have an increase in BMD but not as much as the spine. To the best of my memory, he didn't say anything specifically about the femoral neck. If windyshores is correct that it's 80% cortical, then I'm guessing that any increase there is likely negligible.
He did mention that sometimes the BMD of the forearm decreases with Forteo and Tymlos. Because he brought that up, I think he would have also mentioned if it also happens with the hip.
The best OP drugs for the hip, per Dr McCormick in the same interview, are Evenity (up to 6%) , and Prolia (5-6%).

I was told by my doc that Tymlos is better than Forteo in regard to cortical bone. Maybe that is not true? And Evenity even better. My docs barely use Prolia. The forearm and femur neck are sometimes discussed together as being high in cortical bone. McCormick may have just stuck with spine and hip in the discussion_?

DEXA's of femur neck are not reliable to measure changes, apparently.

@sallyj2 I am repeating what two docs have told me. But if the insert says Tymlos can cause more porosity in cortical bone, I would go with that.

Thank you..all of these comments are very helpful. A question. Why do your docs use prolia so little? I am on evenity and taking note of what every one is saying i order to make a decision about the follow-up to evenity in 6 . months

Just want to say that providers like my doctors and McCormick may have differing opinions on things. If we read studies online they differ as well!

@gravity3 my docs don't use Prolia because it is so difficult to get off. When Prolia is stopped, bone density drops quickly and fracture risk goes up. Docs use Reclast to address this rebound. The rebound with Prolia is different and stronger than any other drug.

My doc joked that he might prescribe it just before retirement so he didn't have to deal with any patient getting off!

Is there anyway to see the bone health summit online?

Hi Candy,
During the summit in early January interviews were made available to view for free over a seven day period. Approximately 10 recorded interviews were made available per day, and only for that day. That's when I watched a large number of them, and took lots of notes. Post-summit it costs --$79 to have unlimited access to all of them, indefinitely. Here's the link: https://morebonehealth.byhealthmeans.com/?idev_id=30380
Most of the same information (but not these specific interviews) is available on YouTube, and on the interviewees' websites and/or in their books. The women who put the summit together, Margie Bissinger, has a great YouTube channel of her own where she posts tons of other interviews, many with the same people from the summit. Here's the link: https://www.youtube.com/channel/UC3-1i9q8ls5FbjOOVeJRW2g