What to do after Tymlos (complicated)

Posted by anewyorker @anewyorker, Sep 25, 2025

Hi to all,

In January I will have completed the two year maximum time on Tymlos, which has worked very well for me (will do DEXA in February). My problem is what to do next.

My endocrinologist wants me to go back on Prolia, which I took for a couple of years a while back with no side effects and moderate gains. My concern is that I have had endless problems with my teeth since I was in my thirties (had the latest extraction yesterday), and all the options, from Reclast to Fosamax (which I can't take because it does awful things to my GERD) to Prolia (which I know this forum is reallhy down on), carry a small but real risk of jaw necrosis, esp for people with a history of dental problems (that's me!).

I can't take Evenity (cardiologist says not to). So I have no idea what to do. Endo says there are no options that don't carry a risk of necrosis. She's a smart lady and is fairly prominent in the field of osteoporosis; she knows what she's talking about. Does anyone have any thoughts?

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

mayblin | @mayblin | May 31 11:37am

In reply to @ipg "@mayblin I will talk either endocrin. May I ask your age. I’ll be 70 soon" + (show)

@ipg i was diagnosed at age 59 with L-spine Tscore of -3.4; started HRT at age 61 after finishing Forteo, 11 years postmenopausal.

ipg | @ipg | May 31 11:47am

In reply to @mayblin "@ipg, i'm doing well, thank you! I was on Forteo for about 2yrs and then transitioned..." + (show)

@mayblin
Did you have any side effects on Forteo? I’m 70. Not sure if HRT would be prescribed?

ipg | @ipg | May 31 1:07pm

In reply to @mayblin "@ipg i was diagnosed at age 59 with L-spine Tscore of -3.4; started HRT at age..." + (show)

@mayblin
Still on HRT? Have you heard about Menostar? Thoughts?

mayblin | @mayblin | May 31 10:24pm

In reply to @ipg "@mayblin Did you have any side effects on Forteo? I’m 70. Not sure if HRT would..." + (show)

@ipg, my experience with Forteo was very positive. I had some fatigue during the first month or two, but it resolved completely once my body adjusted to the medication. And yes i've stayed on HRT ever since finishing Forteo to maintain the bone density gains I made.

Regarding Menostar, it is the lowest-dose estradiol patch (0.014 mg/day) available and is approved for the prevention of osteoporosis. At age 70, a thorough individualized evaluation of cardiovascular and breast cancer risk is prudent before starting HRT, and I’m sure your medical team will help you make that determination.

ipg | @ipg | Jun 1 3:46pm

How long do you stay on Menistar and what did you”fatigue” mean to you? I very active and I don’t want to sleep all day! Good luck

ipg | @ipg | Jun 3 11:04am

In reply to @mayblin "@ipg, my experience with Forteo was very positive. I had some fatigue during the first month..." + (show)

@mayblin
Do you gain weight on Forteo? Lifetime member of weight watchers, can’t afford to gain weight then I’ll need wegovy. Live alone. Worried that fatigue we’ll stop me

mayblin | @mayblin | Jun 3 2:27pm

In reply to @ipg "@mayblin Do you gain weight on Forteo? Lifetime member of weight watchers, can’t afford to gain..." + (show)

@ipg, i did not gain meaningful weight (+/- 2 lb that's all) during or after my treatment with Forteo. Aside from the fatigue, I didn't experience any other side effects.

It’s helpful to remember that 'fatigue' is very subjective. My experience did not involve sleepiness, dizziness, or vertigo; I simply found that lying down at times felt more comfortable. It did not affect my work, driving, or daily activities - though, I often wished I was able to rest more at the time!

I am actually not on Menostar; that dose would be too small for my needs. Generally, once someone begins estrogen, it isn’t advisable to stop without a specific 'backup' plan to avoid losing bone density. My OBGYN is comfortable prescribing HRT for the rest of my life to maintain the gains.

Hope this helps put your mind at ease, and best wishes on your journey.

ipg | @ipg | Jun 3 2:31pm

In reply to @mayblin "@ipg, i did not gain meaningful weight (+/- 2 lb that's all) during or after my..." + (show)

@mayblin
So glad you are doing well. And your age? Any side effects with HRT?

pusheenfan | @pusheenfan | Jun 3 2:47pm

Your concern is understandable, but after completing two years of Tymlos, most osteoporosis specialists recommend following it with an antiresorptive medication to preserve the bone gains, and since you previously tolerated Prolia well and cannot take Evenity or Fosamax, your endocrinologist's recommendation is a common one; while the risk of jaw osteonecrosis is real, it remains quite rare at osteoporosis doses, and many people with dental issues successfully use these medications by working closely with both their endocrinologist and dentist to address major dental work before starting treatment and maintaining careful dental monitoring afterward.