Prescribed Evenity after 2 years on Tymlos.

Posted by mdm30 @mdm30, Mar 20, 2025

I am 65. I just finished 2 years of Tymlos and was given the option to try Evenity due to little improvement on Tymlos. I cannot find any research about this sequence of therapy meds. Has anyone found information on this or has anyone taken this course of treatment?

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You’re not missing anything there really isn’t much solid research on the exact sequence of abaloparatide → romosozumab. Most studies look at Evenity either as a first treatment or after antiresorptives (like bisphosphonates or Prolia). There’s very little high-quality data specifically on switching from Tymlos to Evenity, so you’re right to notice that gap. What doctors are likely thinking (based on how the drugs work): Tymlos = purely anabolic (builds bone)
Evenity = dual effect (builds bone + slows breakdown)
So if Tymlos didn’t give much improvement, Evenity is sometimes used as a “next step” to try a stronger or broader effect — even though that exact sequence isn’t well studied.
From what people report (anecdotally), results are mixed — some see additional gains after switching, others don’t see a huge difference. It’s pretty individual. Big picture, the most proven sequence is still: anabolic → antiresorptive. Whereas anabolic → anabolic (like Tymlos → Evenity) is more based on clinical judgment than strong evidence.
So basically:
you’re right, the research is limited
your doctor isn’t doing something totally out of left field
but expectations should probably be “possible benefit, not guaranteed”
If you do go that route, it’s also worth asking what the long-term plan is after Evenity, since that next step is actually more evidence-based.

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@perknose @perknose I saw a presentation from an endocrinologist that I recall advocated Forteo to Evenity as that doctor's opinion was the best drug response. Sorry that I cannot find that interview for sure, but it might have been the YouTube video that you can find by searching on "The Future of Osteoporosis Treatment" by Dr. Marc N. Wein, MD., PHD". This OsteoBoston talk is well worth watching anyway.

Here is a research paper discussing that:
Therapy with transitions from one bone-forming agent to another: a retrospective cohort study on teriparatide and romosozumab
https://pmc.ncbi.nlm.nih.gov/articles/PMC11601723/
EXCERPT: Regarding therapy switching between bone-forming agents, this study suggests that transitioning from teriparatide to romosozumab increases BMD more effectively than transitioning in the opposite sequence.

If/when I need to go on drug therapy I am going to advocate hard for this sequence for myself.

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