Once on Tymlos, how often are you tested for calcium, vitamin d etc?

My endocrinologist does cmp, vit D, PTH every 6 months. She doesn’t do bone markers in my case because we know that Tymlos is necessary given my 2 spontaneous fractures while on Prolia. Will monitor with Dexa results. I’m on Medicare which allows Dexa every two years she has ordered one between testing periods with specific coding language so fingers crossed Medicare will pay. Test will also fall around my 18 month of Tymlos treatment so am hoping results are positive.

Thanks. It sounds like your tests are similar to @gently and @windyshores. That must be the norm. I’m thinking positive thoughts for you that your dexa is covered and that the results are amazing!

We have to be careful about the vitamin D because too much of it is not good for your bones too little of it is not good for diabetes post menopausal women have to be monitored for their vitamin D and their A1c together. Vitamin D and A1c together tell you if you’re prediabetic or diabetic. So far, my vitamin D hasn’t changed with the Tymlos. I am 67 years old and I am on 5000 units a day. My Enric and doctors were aware of the issue with too much vitamin D in conjunction with the medication and they tested me. I would think that twice a year is appropriate to be tested I always know when my vitamin D is low because I get a little depressed in the morning And then I remember I didn’t take the vitamin D. It really is a mood changer for me. My father also was on vitamin D. If you have when you get older, your body can’t make the vitamin D it needs because the color of your skin will interfere so post menopausal women With all of complexions probably should consult their doctors if they aren’t on any vitamin D whatsoever. It is pretty standard protocol these days. 10 years ago when my D was low borderline 30 my doctors at Ucsd dismissed it, but my A1c was high so I looked it up and it’s a prediabetic condition so I brought them the research and they put me on the vitamin D. My vitamin D hangs out around 52 to 62 and my A1c dropped to 4.8 and I am no longer prediabetic , I started on 1000 units and now I’m on 5000 units .

@gently Hi friends, I’m trying to understand how to find the right specialist for osteoporosis. Do most of you see an endocrinologist, or is there another type of doctor who focuses more on bone health?

My endocrinologist manages both my thyroid and osteoporosis, but she doesn’t order bone turnover markers. She only sends me for a yearly DEXA scan and routine labs like thyroid, calcium, and vitamin D. I’m not sure if this is standard care or if I should look for someone who pays closer attention to bone markers, especially while on tymlos treatment.
I am with her for almost 10 years. My bone density is getting worse that she asked me to take Tymlos. I am tolerated its side effects but the internal dry heat still bad at night. She said it's unrelated and advise me to see GYN or PCP
Thanks for your sharing and help. We're learning together

My endocrinologist tested my bone markers at the start of treatment, and then at 3-6-12 months (along with 12-month DEXA.). He also checked thyroid levels, since Tymlos can affect the parathyroid hormone level.

An endocrinologist is a good choice, but not all of them are really specialists in osteoporosis. It can be hard to find the right one.

@truong62
hypomagnesemia can cause internal dry heat. Tymlos can cause hypomagnesemia. You might try a low dose magnesium supplement. Tymlos can reduce serum levels of vitamin D. Vitamin D deficiency can cause hot flushes. You might try a low dose D3.
I've read so many reports about internal dry heat with Tymlos that I've no doubt that this sense of heat is sometimes a side effect of the Tymlos injection.
Are you taking the injection at night, I wonder.
Your longstanding doctor may be thinking that the flushing is estrogen related. The internal
dry heat seems completely different than the one low estrogen hot flash I had. I'm no expert.
I always think that it is best to have a physician with a single disease practice, but they are so rare. The more patients you have with a particular disease, the more you understand the side effects, and the easier it is to keep up with the research. Rheumatologist deal with inflammatory diseases. Endocrinologist with endocrine diseases. And I think of osteoporosis as primarily endocrine-- hormonal. But there are excellent Rheumatologist treating osteoporosis.
Bone markers are becoming more common as patients request them. They aren't complicated and you can easily read them yourself. With Tymlos I would want a set before beginning and one month in so that you don't suffer the side effects and the cost of the medication without any benefit. Because the effectiveness wanes in the second year as evident in bone markers between 18 and 24 months, it would be good to have a set of bone markers at 18 months, maybe stop Tymlos six months earlier if the advantage of P1NP is overtaken by CTX.
Rarely Tymlos simply isn't effective. I could wish that you had serum lab for PTH intact, and the bone markers. I like your long term doctor because she asked you to take Tymlos. I think it better than the other osteoporosis medications (except maybe Forteo).

@truong62 Hi, I just started teking Tymlos 2 weeks ago and in 2 weeks my Dr is doing a basic metabolic panel and an albumin serum/plasma test to check kidney and liver function. Then I will see her in mid April so she can see how I have been doing and go over bloodwork. I will then ask her what the next step is such as when and what type of blood work is next.