This might be helpful…
Both Tymlos (abaloparatide) and Evenity (romosozumab) are powerful therapies for osteoporosis but they work differently, and which is “better” depends a lot on your situation.
Evenity works by inhibiting a protein called sclerostin, which removes a “brake” on bone formation. That means it stimulates new bone formation AND slows bone loss — a dual effect.
Tymlos instead mimics part of your body’s natural hormone system to stimulate bone-forming cells (osteoblasts), thereby increasing bone formation. It does not directly block bone breakdown.
Because of this, Evenity tends to increase bone density faster and more broadly, while Tymlos focuses on building “new” bone especially in places like spine.
clinical studies
density gains & fracture reduction
Tymlos
In postmenopausal women at high fracture risk, after 18 months Tymlos increased bone density by about 9% at the lumbar spine and 3% at the total hip.
It significantly reduced fracture risk: in the “ACTIVE” trial, vertebral fractures dropped ~86% vs placebo; non-vertebral fractures dropped ~43%.
Evenity
In a 12-month clinical trial, Evenity increased bone mineral density substantially: lumbar spine BMD increased about 12.7%, total hip about 5.8%, femoral neck ~5.2%.
Patients on Evenity had a large reduction in vertebral fracture risk (spine fractures) over that study period.
Where each tends to shine — which may be “better” depends on your bone-health goals
Tymlos might be better when…
You need rapid, substantial bone density increase (spine & hip), e.g. after fractures or very low bone density Evenity — faster gains, dual mechanism. Tymlos still helps, but more slowly.
You prefer longer or flexible treatment, or less frequent shots (daily self-injection) Evenity — monthly by provider (but limited to 12 mo) Tymlos — daily self-injection, can be followed by maintenance therapy (bisphosphonate)
You care about bone quality / remodeling, bone structure & long-term integrity
Tymlos — some experts feel bone built may more closely resemble natural bone remodeling (though data is mixed) Evenity still builds bone but the structure differs (less remodeling).
You have cardiovascular risks or want a safer drug long-term
Tymlos — no major cardiovascular boxed warnings Evenity — carries a boxed warning for increased risk of heart attack/stroke in some patients.
What many doctors recommend: It depends on your starting bone health & fracture risk
If you have very low bone density, history of fracture, or need quick improvement — Evenity may be ideal.
If your bone loss is less severe, or you prefer gradual bone building and value flexibility, or want to avoid cardiovascular risk — Tymlos may be a better fit.
Sometimes doctors may start with Evenity (if risk high), then follow with a maintenance treatment (e.g. bisphosphonate), or use Tymlos — depending on tolerance, personal health, and response.
A couple of important caveats
Even though Evenity builds bone quickly and broadly, it has a boxed warning for cardiovascular risk (heart attack, stroke) so it may not be suitable for people with existing heart disease or high risk.
@osteopatient2026
I'll post this in the hope that others "read the fine print" about the Medicare Part D out-of-pocket limit.
Yes, there is a $2,100 limit on how much you pay for your drugs in a year with Medicare Part D. However that doesn't include the cost of the premiums. In my area, there is only one plan that has Tymlos in its formulary, and it costs $123/month (a.k.a., $1,476/year). Add the premiums to the $2,100 and you get $3,576/year (so my $3K estimate was actually too small).
@osteopatient2026
I'll post this in the hope that others "read the fine print" about the Medicare Part D out-of-pocket limit.
Yes, there is a $2,100 limit on how much you pay for your drugs in a year with Medicare Part D. However that doesn't include the cost of the premiums. In my area, there is only one plan that has Tymlos in its formulary, and it costs $123/month (a.k.a., $1,476/year). Add the premiums to the $2,100 and you get $3,576/year (so my $3K estimate was actually too small).
@norahguil
According to the outlined protocol from Evenity if you have not had a stroke (including TIA) or cardiovascular event within the last year and have no other known cardiovascular issues (you should see a cardiologist) the risk is very low.
There are so many other drugs that many of us take every day including just the vitamin Niacin that are known to cause or precipitate cardiovascular events…asprin is a well known one many people die from internal bleeding every year. It helps to keep things in proper perspective knowing this.
You and your doctor still have the final say so as what you think is the best plan. If your T Score's (as fuzzy as they can be) are really bad -3 to -3.3 or worse (mine is -4.8) you may be at severe risk for a fracture…
I opted to go the Tymlos anabolic route. I’m only 65 and otherwise healthy with no known cardiovascular issues…I may look at Evenity as an alternative if I don’t get good improvement from Tymlos.
I am also doing “heel drops” with some weights not too much weight though, taking calcium through nonfat milk and some vitamins to get 1200mg per day total. (Keep an eye on getting blood checked for too much calcium) some vitamin D and K small amount of magnesium and a few others not too much. Walking etc. -2 degrees out now! So treadmill works.
Thank you for your kind reply. The thing is, I am trying to decide for my elderly Mum who is 97 years old and has already had a few fractures. Up until recently, she was walking still, with a walker until she fell and sustained a pelvic fracture and a fracture in the sacrum. I have no idea what her T score is (probably low) but she has had osteoporosis for some years now and she also suffered from rheumatoid arthritis as a child of 9. The doctor at the care home ( in Canada) keeps pushing for the PROLIA medication but the more review I read about the effects I am leaning towards rejecting it for my Mother who other than the dementia, is stable, healthy with no stroke or heart issues. She has been stable for a long time. She only takes the dementia medication as well as calcium ( 500gr) and Vit D. That is all. She still enjoys life ( within her reality) I was leaning towards the FORTEO but have been told one of the criteria is that she would have had to have been on one of the osteoporosis meds first and not done well with it ( so the Prolia) before they'd consider to put her on Forteo. I am leaning towards the Tymlos but this drug is not available in Canada yet apparently and this means my options are limited and I definetely do not want the Prolia.
I’m not a doctor but I can see why at 97 they may not want to put her through daily injections that takes 18-24 months to see improvement.
What part of Canada? When I heard “Mum” I thought has to be Canada. My mother’s side is from the Ontario area.
They do things a little different there. The Evenity is suppose to build and prevent fractures within a year but not knowing all the particulars you check with the doctors…maybe ask for a second opinion if possible.
What does your doctor recommend? I’ve been on both but have not had a DEXA yet since taking them. In my case, insurance would no longer cover Tymlos so I had to switch to generic Forteo. I had intolerable side effects from the Forteo so I found an endocrinologist and she got me approval to take Evenity.
I am just happy to be on an anabolic (bone building) medication. I’d take whichever one worked and would have stayed on Tymlos if that had been possible.
That said, I do like that Evenity is only for 12 months and that I don’t have to inject myself daily like I did with Tymlos. I’m looking forward to seeing how well it worked.
Thank you for your kind reply. The thing is, I am trying to decide for my elderly Mum who is 97 years old and has already had a few fractures. Up until recently, she was walking still, with a walker until she fell and sustained a pelvic fracture and a fracture in the sacrum. I have no idea what her T score is (probably low) but she has had osteoporosis for some years now and she also suffered from rheumatoid arthritis as a child of 9. The doctor at the care home ( in Canada) keeps pushing for the PROLIA medication but the more review I read about the effects I am leaning towards rejecting it for my Mother who other than the dementia, is stable, healthy with no stroke or heart issues. She has been stable for a long time. She only takes the dementia medication as well as calcium ( 500gr) and Vit D. That is all. She still enjoys life ( within her reality) I was leaning towards the FORTEO but have been told one of the criteria is that she would have had to have been on one of the osteoporosis meds first and not done well with it ( so the Prolia) before they'd consider to put her on Forteo. I am leaning towards the Tymlos but this drug is not available in Canada yet apparently and this means my options are limited and I definetely do not want the Prolia.
@norahguil Why are you reluctant to use Prolia? At your mum's age, keeping her on Prolia for the rest of her life might help her avoid any more fractures. And it avoids daily injections which would be uncomfortable.
@norahguil Why are you reluctant to use Prolia? At your mum's age, keeping her on Prolia for the rest of her life might help her avoid any more fractures. And it avoids daily injections which would be uncomfortable.
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This might be helpful…
Both Tymlos (abaloparatide) and Evenity (romosozumab) are powerful therapies for osteoporosis but they work differently, and which is “better” depends a lot on your situation.
Evenity works by inhibiting a protein called sclerostin, which removes a “brake” on bone formation. That means it stimulates new bone formation AND slows bone loss — a dual effect.
Tymlos instead mimics part of your body’s natural hormone system to stimulate bone-forming cells (osteoblasts), thereby increasing bone formation. It does not directly block bone breakdown.
Because of this, Evenity tends to increase bone density faster and more broadly, while Tymlos focuses on building “new” bone especially in places like spine.
clinical studies
density gains & fracture reduction
Tymlos
In postmenopausal women at high fracture risk, after 18 months Tymlos increased bone density by about 9% at the lumbar spine and 3% at the total hip.
It significantly reduced fracture risk: in the “ACTIVE” trial, vertebral fractures dropped ~86% vs placebo; non-vertebral fractures dropped ~43%.
Evenity
In a 12-month clinical trial, Evenity increased bone mineral density substantially: lumbar spine BMD increased about 12.7%, total hip about 5.8%, femoral neck ~5.2%.
Patients on Evenity had a large reduction in vertebral fracture risk (spine fractures) over that study period.
Where each tends to shine — which may be “better” depends on your bone-health goals
Tymlos might be better when…
You need rapid, substantial bone density increase (spine & hip), e.g. after fractures or very low bone density Evenity — faster gains, dual mechanism. Tymlos still helps, but more slowly.
You prefer longer or flexible treatment, or less frequent shots (daily self-injection) Evenity — monthly by provider (but limited to 12 mo) Tymlos — daily self-injection, can be followed by maintenance therapy (bisphosphonate)
You care about bone quality / remodeling, bone structure & long-term integrity
Tymlos — some experts feel bone built may more closely resemble natural bone remodeling (though data is mixed) Evenity still builds bone but the structure differs (less remodeling).
You have cardiovascular risks or want a safer drug long-term
Tymlos — no major cardiovascular boxed warnings Evenity — carries a boxed warning for increased risk of heart attack/stroke in some patients.
What many doctors recommend: It depends on your starting bone health & fracture risk
If you have very low bone density, history of fracture, or need quick improvement — Evenity may be ideal.
If your bone loss is less severe, or you prefer gradual bone building and value flexibility, or want to avoid cardiovascular risk — Tymlos may be a better fit.
Sometimes doctors may start with Evenity (if risk high), then follow with a maintenance treatment (e.g. bisphosphonate), or use Tymlos — depending on tolerance, personal health, and response.
A couple of important caveats
Even though Evenity builds bone quickly and broadly, it has a boxed warning for cardiovascular risk (heart attack, stroke) so it may not be suitable for people with existing heart disease or high risk.
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3 Reactions@osteopatient2026
I'll post this in the hope that others "read the fine print" about the Medicare Part D out-of-pocket limit.
Yes, there is a $2,100 limit on how much you pay for your drugs in a year with Medicare Part D. However that doesn't include the cost of the premiums. In my area, there is only one plan that has Tymlos in its formulary, and it costs $123/month (a.k.a., $1,476/year). Add the premiums to the $2,100 and you get $3,576/year (so my $3K estimate was actually too small).
cbusgma2017,
excellent choice, Tymlos. I'm not sure how deep you want to dive. https://www.nature.com/articles/s41413-022-00219-8 It is a little difficult to get past the marketing for Evenity.
@gently
Good interesting article.
@cbusgma2017
Yes …I guess in my case I was just referring to the drug portion …since I have to pay the other anyway.
@osteopatient2026
Thank you for your kind reply. The thing is, I am trying to decide for my elderly Mum who is 97 years old and has already had a few fractures. Up until recently, she was walking still, with a walker until she fell and sustained a pelvic fracture and a fracture in the sacrum. I have no idea what her T score is (probably low) but she has had osteoporosis for some years now and she also suffered from rheumatoid arthritis as a child of 9. The doctor at the care home ( in Canada) keeps pushing for the PROLIA medication but the more review I read about the effects I am leaning towards rejecting it for my Mother who other than the dementia, is stable, healthy with no stroke or heart issues. She has been stable for a long time. She only takes the dementia medication as well as calcium ( 500gr) and Vit D. That is all. She still enjoys life ( within her reality) I was leaning towards the FORTEO but have been told one of the criteria is that she would have had to have been on one of the osteoporosis meds first and not done well with it ( so the Prolia) before they'd consider to put her on Forteo. I am leaning towards the Tymlos but this drug is not available in Canada yet apparently and this means my options are limited and I definetely do not want the Prolia.
I’m not a doctor but I can see why at 97 they may not want to put her through daily injections that takes 18-24 months to see improvement.
What part of Canada? When I heard “Mum” I thought has to be Canada. My mother’s side is from the Ontario area.
They do things a little different there. The Evenity is suppose to build and prevent fractures within a year but not knowing all the particulars you check with the doctors…maybe ask for a second opinion if possible.
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Helpful -
Hug
1 ReactionWhat does your doctor recommend? I’ve been on both but have not had a DEXA yet since taking them. In my case, insurance would no longer cover Tymlos so I had to switch to generic Forteo. I had intolerable side effects from the Forteo so I found an endocrinologist and she got me approval to take Evenity.
I am just happy to be on an anabolic (bone building) medication. I’d take whichever one worked and would have stayed on Tymlos if that had been possible.
That said, I do like that Evenity is only for 12 months and that I don’t have to inject myself daily like I did with Tymlos. I’m looking forward to seeing how well it worked.
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Like -
Helpful -
Hug
4 Reactions@norahguil Why are you reluctant to use Prolia? At your mum's age, keeping her on Prolia for the rest of her life might help her avoid any more fractures. And it avoids daily injections which would be uncomfortable.
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1 Reaction@oopsiedaisy Completely agree.