Tymlos treatment plan - 18 months vs 24

The problem, as usual, is the health insurer. Many, perhaps all, still have the restriction "no more than 24 months of Tymlos or Forteo", unless you have shown that you are still at a high risk of fracture / T-scores still bad.

I'm impressed with your knowledge, and I probably only partially understood everything here, but I keep thinking that if you take Tymlos or Forteo, it moves the needle back on osteoporosis, but only temporarily. It eventually goes back downhill so this is just buying you a little time. I wonder if the side effects and risks are worth a temporary improvement. With so much of the population increasing in age, you would think there would be more research.

loh, this really is a risk/benefit decision. It's a little tough because we have to guess at both the risk and the benefit.
I didn't reach the same conclusion that you may have. If moving the needle back on osteoporosis two years means two additional years without fracture, I'd opt for the two years free of pain. But if a person were to decide that taking the drug is only good for two years, they might consider that without the drug in two years their bones will be much weaker than they are now. Even if you don't fracture in the two years without medication, the likelihood of fracture in the following two is much greater. It is easier to slow the loss of bone than to replace the lost bone.
Scaling the side effects of the medications appears a little different for me. The risks with Forteo are close to 0. At the very worst you could have 24 hours of discomfort. It is more like four hours. But then you can reassess and quit the drug.
On the other side of the scale is the risk of fracture. We are most susceptible in the spine. You may already know that spinal compression fractures never heal to their original shape. This change in shape can affect the function of your entire spine, providing endless pain.
The other drugs weigh heavier in possible side effects in this order Tymlos, Reclast. oral bisphosphonates, Evenity and then Prolia.
There is some interesting research. Someday we may not have to make these difficult choices.
It would be a tough choice for me if it weren't for Forteo. For very few, the choice of some of the medications has proven to be not worth the side effects.
Bless your choice with luck.

The way Dr. McCormick put it is that Tymlos or Forteo buys you time. Or, as you put it, where would you rather be in two years? At that time, then we can figure out what is next. There's no 20-year grand plan, sadly.

loh, this really is a risk/benefit decision. It's a little tough because we have to guess at both the risk and the benefit.
I didn't reach the same conclusion that you may have. If moving the needle back on osteoporosis two years means two additional years without fracture, I'd opt for the two years free of pain. But if a person were to decide that taking the drug is only good for two years, they might consider that without the drug in two years their bones will be much weaker than they are now. Even if you don't fracture in the two years without medication, the likelihood of fracture in the following two is much greater. It is easier to slow the loss of bone than to replace the lost bone.
Scaling the side effects of the medications appears a little different for me. The risks with Forteo are close to 0. At the very worst you could have 24 hours of discomfort. It is more like four hours. But then you can reassess and quit the drug.
On the other side of the scale is the risk of fracture. We are most susceptible in the spine. You may already know that spinal compression fractures never heal to their original shape. This change in shape can affect the function of your entire spine, providing endless pain.
The other drugs weigh heavier in possible side effects in this order Tymlos, Reclast. oral bisphosphonates, Evenity and then Prolia.
There is some interesting research. Someday we may not have to make these difficult choices.
It would be a tough choice for me if it weren't for Forteo. For very few, the choice of some of the medications has proven to be not worth the side effects.
Bless your choice with luck.

loh, this really is a risk/benefit decision. It's a little tough because we have to guess at both the risk and the benefit.
I didn't reach the same conclusion that you may have. If moving the needle back on osteoporosis two years means two additional years without fracture, I'd opt for the two years free of pain. But if a person were to decide that taking the drug is only good for two years, they might consider that without the drug in two years their bones will be much weaker than they are now. Even if you don't fracture in the two years without medication, the likelihood of fracture in the following two is much greater. It is easier to slow the loss of bone than to replace the lost bone.
Scaling the side effects of the medications appears a little different for me. The risks with Forteo are close to 0. At the very worst you could have 24 hours of discomfort. It is more like four hours. But then you can reassess and quit the drug.
On the other side of the scale is the risk of fracture. We are most susceptible in the spine. You may already know that spinal compression fractures never heal to their original shape. This change in shape can affect the function of your entire spine, providing endless pain.
The other drugs weigh heavier in possible side effects in this order Tymlos, Reclast. oral bisphosphonates, Evenity and then Prolia.
There is some interesting research. Someday we may not have to make these difficult choices.
It would be a tough choice for me if it weren't for Forteo. For very few, the choice of some of the medications has proven to be not worth the side effects.
Bless your choice with luck.

wondering1, I have been thinking, without knowing. The research is powered in directions that don't answer the questions we have. From the research we understand that these two anabolics lessen in effect after 15 month in most patients in clinical trials. Theory from bone markers is that while PTH therapy increases bone building cells rapidly at onset of treatment, but the presence of those cells increases the number of cells that break bone down until at about 15 months the patient has diminished osteoanabolic effect. Since it appears to be true that bone markers predict the three month effect of increased mineralized bone. It would be sensible to test bone markers at the 13th and then the 15th month. When those markers indicate a slowing down of bone growth stop the injections. From my limited experience, three weeks off the injections drops the CTX more rapidly than the P1NP, which also drops. This is not presently an approved use of bone markers. To your point, I think that the pause before the second phase restarts the initial benefits resetting the process. Individual results indicates that the risks, not cancer, but hypercalcemia and hyperparathyroidism are not inherent in the medication, but is hidden in some few individual's genetics.
From the clinicals we know that when you stop taking Tymlos or Forteo, whatever caused a person's osteoporosis will resume causing that loss of bone. Current protocol is to take and antiresorptive, usually Reclast before taking yet another medication.
Because of financial incentives and separately the political climate, I don't think there will ever be clinical trials.

mint, https://pmc.ncbi.nlm.nih.gov/articles/PMC6422956/
There is a subset of individuals who continue to maintain coupled bone markers longer than 24 months. Most of the studies are just to 18 months where you see at somewhere approaching 18 month there is this increase in CTX without the accompanying P1NP. If you are wondering about staying on Tymlos longer than 18 months, it is best to have you bone markers tested. There are doctors prescribing longer terms of treatment with both Forteo and Tymlos. I'm starting my fourth year of Forteo, checking serum bone markers every three months.
Research isn't telling us yet why the balance changes. Maybe resource depletion. We don't even know it the shift is transient. And if a person were to continue the medication after the decline we don't know if it would rise again. The pth drugs have my favored mechanism, so I'd like to remain on Forteo or Tymlos and avoid all the others.

@gently Thank you for the information. That's very interesting.
I did find a research article on the effectiveness of treatment up to 24 months.
In case anyone is interested, the title is "Teriparatide for osteoporosis: importance of the full course" https://pmc.ncbi.nlm.nih.gov/articles/PMC4947115/
The conclusion is: "Both the biochemical and histological data suggest ongoing bone formation through 24 months, resulting in increases in bone mass, even in patients with low bone turnover induced by long-term previous anti-resorptive treatment. Consistent with these observations, bone mass and strength increase and fracture risk decreases during longer treatment with the drug."