'Step' requirement for meds and Tymlos

@beccac
Yes…The research I did said because Tymlos can raise calcium and it’s rare that it would lower it. The guidance I found said not to take more than 1000-1200mg per day. Unless your doctor (blood tests suggest it) and Don’t take it all at once.
So I figured with my two cups of weak coffee with non fat milk and oatmeal in the morning with my multivitamin (300mg calcium) I was already getting 600mg of calcium.
At lunch I took my half of 600mg (300 for those math impaired) calcium supplement…by the end of dinner I had my other 2 cups of coffee reaching 1200mg.
The hidden recommendations are don’t take or have any calcium within 2 hours of your injection. Your kidneys go into over drive and other things can cause the nausea.
It worked …I feel great this am. Doctors and the Tymlos company really should print this out for the few that do have these problems…

@beccac you are correct…the numbers are in the right territory depending where they come from and how they are interpreted…you generally don’t hear from those with no fear or issues. 😇

What kind of doctor are you seeing? Best to talk to a Endocrinologist. Don't rely on the internet. I did that, and became really confused. I talked to my Endocrinologist. He went over my recent Dexascan, and had me make an appointment with his Clinical Pharmacist. She went over all my medical history, and talked about all the options regarding osteoporosis meds. Very very informative. Also Bisphosphonate are not necessarily the first one you start with. Each of the medications all have specific contradictions. I did not know this. For an example, if you had a stroke, or have heart disease, you can't take a certain medications. This is just one example
This is why you need to talk to the right people for through and proper education.
My primary doc initially wanted me to take Fossamax (bisphosphonate). It was the wrong decision. That is why you go to a specialist. Plus talk to a clinical Pharmacist who know drugs.

I ended up going on Tymlos. I had a really hard time starting it. I too was so afraid of side effects! I had to titrate
the drug-started with 2mcg and worked my way up to the full dose. This helped my psyche. Start at a low dose then work up.

@beccac I have done all three anabolics after years on oral alendronate. I had a fracture after 5+ years on Fosamax. Insurance approved Tymlos and I was doing OK on it (minor side effects) but they pulled my authorization and forced me onto generic Forteo which I was not able to tolerate. I found a wonderful endocrinologist who got me approved for Evenity and I've had 7 doses so far.

With your hips as bad as they are, Tymlos or Forteo would be a good choice. The ideal treatment plan now is to start with the anabolic because the bisphosphonates can mute the response of an anabolic if taken first. This is the situation I am in now. I won't know if the anabolic therapy has worked until next year. I am hopeful but it would have been better not to have taken the bisphosphonate first.

Yeah, that's the conclusion I've drawn after research. Appts for docs are incredibly far apart, I've had one, but I did get a response today in the portal from the ortho PA - I just had asked if she would be willing to start with Fortios or Tymlos and wondered if my Medicare/QMB dual would pay for it. She said "Yes, probably" so if I decide to go the Med route at least I think they'll push for authorization. It's a Hopkins clinic so at least they're up on the research - they published their own paper saying that an anabolic should go first. I hate the dead end -> biophosphate standard tx though - it really is just all about the money. I'm almost certain it wld be the generic Fortio, also. Seems to get worse reports than the brand. Worth a try - at least if you quit it it gets out of the system quickly. Hope very much that the Evenity works out for you! Appreciate your replies very much.

The research shows Evenity is the fastest bone builder so far 12 months one visit to get your shot per month. It has some rare cardiovascular adverse reactions vs side effects. Your doctor will help make the determination if you are a safe candidate or not. If you had stroke or heart attack in the last year.
After that the newer drug Tymlos has a slight edge but according to the data not significant edge over Forteo.
Forteo has a longer track record. But my doctor says most do just fine on Tymlos followed by Reclast or Prolia. Prolia is a whole other subject. Depends on a lot of factors….
The good thing with Tymlos, at least in my mind, mirage may vary for others, Tymlos will allow me to do some dental work without fear of ONJ.

Yeah, I wouldn't go near Prolia myself. Very wary of all of the bisphosphonates. But if you check out the hip fracture forum in here... well, wary is not the word. I'd be great with being in a study test group for long term anabolic use - nobody's doing that because they're so expensive, no advantage to insurers in success. Some suggest a course of anabolics with lots of serious exercise and nutrient focus during and after to see if deterioration can be stabilized or slowed down, but if you're a wobbly crooked little old never-athletic lady like me that heavy duty exercise regime is never going to happen. Sigh. Good luck!!

@beccac
Check out these two videos…near the bottom…they are long but informative…I speed them up to 1.5…still listenable.
https://connect.mayoclinic.org/discussion/can-one-stop-taking-prolia-after-the-first-shot/

Thanks - they do a good job of summarizing some of the bits and pieces I've been assembling into something like clarity. As is typical, neither video much address the less rare side effects that result in many pts discontinuing the meds. - I forget the percentage but it's high. She just shrugs off "stuff like indigestion and gas' . Large numbers of people don't discontinue important medication because they have a little tummy trouble, as is attested by a lot of anguished people in this forum.
On the other hand, none of them are as awful as a serious fracture, especially of the hip. That's often absolutely catastrophic. Honestly, I'd much rather die of a stroke or heart attack than endure the frequently long slow death of an elder's hip fracture. I really hate the rebound effect data. It's easy to think about the next few years, but even at 74 I'm just really concerned about the long term implications of these drugs. And bone docs focus on bone - Ive seen CA docs prescribe txs to terminally ill patients that maybe slow down a tumor but absolutely devastate their quality of life, seen terminally ill pts driven through excruciating and pointless PT regimes (retired hospice therapist here) - it just goes with specialist territory. My hip and femur are at 4, bad, spine is just osteopenia - took me a while just to sort that out I was so focused on figuring out the meds. It's only been a week or so since diagnosis, sigh. In any case I think it's still an absolutely miserable decision. I dunno yet.