How long after stop Tymlos to start another drug w/o losing gains?

What has your endocrinologist said about timing this transition?

did you see any gains on Tymlos also what are the suggesting. I am 6 months in and if I see big gains may just go the diet and exercise route after the 2 year Tymlos.

My endo has told me that he wants a round of labs 2 weeks after my stopping Tymlos (to see where CTX is) and then wants me on ReClast not longer than a month after my last Tymlos shot. He then wants to see labs (CTX) again 3 months after the ReClast infusion and hopes it will have dropped my CTX by 50%. Hope this helps..... good luck. Move quickly! (And I have read in Dr. McCormick's book "Great Bones" that regular bisphosphonates are not strong enough to prevent the rebound coming off the anabolics (teriperatide and Tymlos) and it needs to be ReClast which is much stronger.

@gravity3 My plan was to start the day after ending Tymlos; we didn't discuss anything further regarding how long the transition could be as it was already decided.

@michieg Thanks for sharing your experience! My endo does not really do the bone markers but was ok with me scheduling it for myself. My CTX is 165 after Tymlos; she said it looked fine for finishing Tymlos. She's not a fan of doing Reclast unless Fosamax doesn't work or isn't tolerated.

@chrisdietrich I did have good gains on Tymlos after 12 months on it and presumably that continued until I stopped at 18 months (my endo wanted me to do 18 months, not 2 years). From everything my endo has said and I have read, after Tymlos a bisphosphonate is important to hold the gains since the bone remodeling gets a bit skewed on Tymlos so the bisphosphonate brings more of the bone remodeling pattern back. And diet and exercise are important during and after meds. After the bisphosphonate, I guess the hope is to not be on more drugs but to stabilize with a good diet and exercise routine. Whether that is realistic, I don't know.

From everything I’ve read and what my doctor emphasized, once you stop Tymlos you really don’t want to leave a gap before starting a bisphosphonate because the bone you built isn’t “locked in” yet and turnover can ramp back up pretty quickly, so while it’s not like you lose everything overnight there is a gradual reversal that can start sooner than people expect, which is why most recommendations are to start something like alendronate or even an infusion like zoledronic acid basically right away (next day or within a few days at most) to preserve those gains, and if there’s any unavoidable delay (insurance, scheduling, etc.) it’s worth pushing to shorten that window as much as possible or asking your doctor about a temporary bridge because the whole goal is to prevent that post-Tymlos drop-off from even getting started rather than trying to recover lost ground later.

@hopeandhope I am testing that theory out right now. I stopped Tymlos in January after two years. I'm now on the weekly alendronate pill.

I will have a blood test soon to check my bone markers, and I'm sure I'll do it again at six months. Next January will be the DEXA.

The plan is to stop all medication at that point, and then monitor. The doctor said I might have a little dip in bone density, but given that Tymlos brought me from -3.3 to -1.7, I've got some wiggle room.

I get plenty of the proper exercise, so I'm hopeful. We will see...

@hopeandhope thanks for the info can you share your T-Scores so that I can get a reference.
Thanks again!

@pusheenfan Good points! Thanks! I agree with you - my endo just got back to me and said to start alendronate and if I have issues, we'll switch to zoledronic acid. She still didn't tell me what the transition time should be, but since most people say pretty much immediately, that is what I will do. This journey is hard and stressful....