Is tymlos or evenity better for osteoporosis

@rjd

Hi, well I have read a lot of reviews of people that are on Prolia and the reviews are more negative than positive. A lot of pain in the joints etc dentists are against the prolia too.

@gravity3
Generally forteo and Tymlos are anabolic…they work by stimulating the thyroid (parathyroid) that is partially responsible for telling the “managers” osteocytes to tell the osteoclasts to get to work building.
Some of these drugs like bisphosonates are just anti reabsorbitives that is they slow or stop the osteoclasts from cleaning old bone thus helping slow or reduce bone loss. Weight bearing excercise done with proper supervision has been shown to help stimulate bone growth without drugs. The issue can be is if your scores are really bad (and we don’t really have a readily available way to test bone strength thst all the doctors and research can agree on like REMS) then we just use DEXA scans. Not really the best but what is used.
So the reason you start with a bone builder is to build the structure of bone and keep the gains with a bisphosphonate …that’s what is called sequencing.
There are different approaches and success depending on you your body Doctor and your diet.
Excercise age…oh so many factors…it’s not as simple as just taking a supplement as some would have you believe…if you have really bad tscores you don’t have the time or risk that someone may have been able to successfully reduce their scores with…everyone’s body is different…
Sounds like you are asking all the right questions or as my professor used to say “there are no dumb questions”❤️
Evenity is newer and works entirely differently…it affects sclerostin and yet allows bone growth while building…that’s better in theory

@osteopatient2026
This was my question for @gently (that is, what are your sources for Tymlos making better bone than Evenity).

@gently responded with a link to an article in nature.org entitled "Bone remodeling: an operational process ensuring survival and bone mechanical competence". You can google it
(I am apparently too new a member of this community to post the actual link).

I'm still working on understanding the article (it's very technical).

@cbusgma2017
At the most basic level you can't remodel bone without osteoclasts. Evenity works primarily by blocking osteoclasts just like the bisphosphonates and Prolia, all three by different methods.
We've come to think of osteoclasts--the cells that break down bone as the enemy. But osteoclasts don't break down bone at random. They are attracted to sites where the bone is weak, damaged, fissured. (As much as I dislike metaphors) you would never wax your floor or your car without cleaning it first. Medications that block the osteoclasts are doing just that to your bones. Leaving damaged portions underneath the new fresh bone. Those damaged portions have lost vascular and nerve viability. So you have encased in the new bone the potential for osteonecrosis.
Chrondrocytes need sclerostin for maintenance and development. Chondrocytes necessary for the production of collagen. Because the PTH drugs increase the production of chondrocytes they are able to rebuild the cartilaginous pre-structures that are needed to replace lost trabecular bone. Evenity blocks sclerostin.
Within joints you lose also lose the extracellular matrix for maintenance joint function. Without sclerostin, cartilage becomes bone in the form of bone spurs.
Evenity does add bone between the periosteum and the endosteum. Sometimes where there had never been bone before. Heavy thick bone and if you measure strength by density alone, you'll believe heavier is stronger.

But the whole purpose of osteoporosis medications is to prevent fracture. And all of these medications are effective for some and ineffective for the few.

@gently
This makes tremendous sense to me. Preventing osteoclasts from doing their "clean up" operation while super-charging osteoblasts to create new bone does sound like it would wax over the dirt on the floor. Also, from my naive perspective, doing something like building bone in slower motion (over 12-24 months) seems like a better approach than growing it super fast (< 12 months).

But folksy images ain't science! I trust the research (though slow-and-steady-wins-the-race images might help keep my spirits up over the next 12-24 months of potentially unpleasant side effects).

Thanks for your posts on this @gently. They help a lot.

@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.

@cbusgma2017

From 3 studies I was able to look at quickly, Evenity in no way suppresses osteoclast activity the same way as the anti-resorptives do. I would not be afraid to use it for that reason; in fact, it will be my drug of choice,

@cbusgma2017

From 3 studies I was able to look at quickly, Evenity in no way suppresses osteoclast activity the same way as the anti-resorptives do. I would not be afraid to use it for that reason; in fact, it will be my drug of choice,

@normahorn
Evenity (romosozumab) does transiently suppress osteoclast activity.
Here’s a more clear explanation:
Evenity is a monoclonal antibody that targets sclerostin, a protein that normally inhibits bone formation.
When sclerostin is blocked:
Osteoblast activity increases → bone is built faster.
Osteoclast activity decreases → bone breakdown slows down.
So Evenity has a dual effect:
Strong anabolic (bone-building) phase during the first few months.
Mild anti-resorptive (osteoclast-suppressing) effect throughout treatment.
How much does it suppress osteoclasts?
It does not suppress osteoclasts as strongly as:
Bisphosphonates (alendronate, risedronate)
Denosumab (Prolia)
Its effect is moderate, not complete, and is part of why bone density rises so quickly the first year.
Why this matters
The osteoblast surge builds bone.
The osteoclast suppression helps retain the new bone.
After finishing Evenity, most patients go onto an anti-resorptive (usually Prolia or a bisphosphonate) to preserve gains — because osteoclast activity rebounds once Evenity stops.