I wonder if Tymlos and Forteo only help trabecular bones.

I’m so sorry! That’s why I’m afraid of those drugs because there can be slight breakdown of cortical bone as mentioned in the patient pamphlets. What do your doctors say about Evenuty? It is supposed to be better for non-vertebral bones from what I’ve read and been told, I had a friend with a leg fracture that wasn’t healing who was told to add strontium citrate. I’m just still shocked that we can’t have reliable information, I hope you begin to heal quickly.

Thanks for your response @sallyj2. I was wondering about Evenity and will talk to my endo about it. I'm so sensitive to so many meds that I liked the idea of taking a lower dose of Tymlos. I haven't seen the patient pamphlets that show that there can be breakdown of cortical bone, but since they state that it must be true. I am taking a half dose of strontium citrate. Did your friend's leg finally heal?

Hi @drsueflower, I'm on forteo therapy now. At 13 month, my dexa showed 4.5%improvement at L spine. However, dexa reading had a closer to 8% decrease in bmd at hip/femoral neck. The conflicting results puzzled me for a while. In recent months, the dexa was reexamined and showed there were technical errors involved. My endo concluded that there had no changes in hip or femur neck for me, while L spine indeed improved 4.5%. This is a great news to me since my main problem is spine area.

The clinical studies shows that forteo indeed has largest impact on trabacular bones, so are other 2 anabolics tymlos and evenity. For hip and femur neck, evenity seems having largest impact, then tymlos then forteo. There are variations among population. If one individual had a good results with one drug, it does not mean the result will be the same for another. The results from various trials are average among the population the tested.

I'm wondering your tymlos' dose. Tymlos is a similar drug compared to forteo. For fair comparison, a 20mcg forteo is more or less comparable to a full dose of tymlos at 80mcg, not at a lower dose, although tymlos dose could be adjusted/titrated for those who need it due to severity of side effects. To be fully effective against future fracture, you might be needing a full dose of tymlos, 80mcg. Discuss this with your doctor.

Also bear in mind that a dexa reading itself might not reflect the true bone strength. There aren't good measure for bone strength. Both "tymlos and forteo increase the periosteal and endosteal perimeters, resulting in a larger, more structurally sound bone", this may not shown in bmd increase in dexa scan. But the fracture reduction is evident in clinical trial for both drugs, with tymlos showing a slight advantage.

@drsuefowler I had a 9% increase in bone density in my hip and 20% in spine. Tymlos is better than Forteo in this regard, I have been told.

Tymlos is supposed to help with healing but it is possible that is less true with cortical bone.

I know you had trouble with higher doses but I personally would be nervous continuing on 40 mcg. I would push the dose up. Yes there are side effects but even if you do a year at 6 or 7 clicks you might have gains.

At some point in this forum I expressed concern that my posts about "ramping up" and "partial doses" might cause harm to some people if misinterpreted. I only did the ramping up in order to be able to tolerate a therapeutic dose. And I was never, ever without side effects. I just wanted to tolerate it, which you understand.

Maybe it was you, I don't remember, but I expressed concern about a 20mcg dose as being too low and feeling responsible for introducing this idea of ramping up!

Hi @drsueflower, I'm on forteo therapy now. At 13 month, my dexa showed 4.5%improvement at L spine. However, dexa reading had a closer to 8% decrease in bmd at hip/femoral neck. The conflicting results puzzled me for a while. In recent months, the dexa was reexamined and showed there were technical errors involved. My endo concluded that there had no changes in hip or femur neck for me, while L spine indeed improved 4.5%. This is a great news to me since my main problem is spine area.

The clinical studies shows that forteo indeed has largest impact on trabacular bones, so are other 2 anabolics tymlos and evenity. For hip and femur neck, evenity seems having largest impact, then tymlos then forteo. There are variations among population. If one individual had a good results with one drug, it does not mean the result will be the same for another. The results from various trials are average among the population the tested.

I'm wondering your tymlos' dose. Tymlos is a similar drug compared to forteo. For fair comparison, a 20mcg forteo is more or less comparable to a full dose of tymlos at 80mcg, not at a lower dose, although tymlos dose could be adjusted/titrated for those who need it due to severity of side effects. To be fully effective against future fracture, you might be needing a full dose of tymlos, 80mcg. Discuss this with your doctor.

Also bear in mind that a dexa reading itself might not reflect the true bone strength. There aren't good measure for bone strength. Both "tymlos and forteo increase the periosteal and endosteal perimeters, resulting in a larger, more structurally sound bone", this may not shown in bmd increase in dexa scan. But the fracture reduction is evident in clinical trial for both drugs, with tymlos showing a slight advantage.

Please go to Evenity’s website - if I understand what I’m reading and, based on personal results, Evenity offers (and touts) better vertebral t-scores. My increases after about 9 months of Tymlos and 4 of Evenity were good at the femoral neck, however my spinal gains were excellent. Docs don’t even know what they’re talking about, how can we?

Yes, it did!