Short answer: Tymlos (abaloparatide) is 80 mcg injected under the skin once a day at home, for postmenopausal women and men with osteoporosis at high fracture risk; use beyond 2 years in a lifetime is not recommended.1 Evenity (romosozumab) is two injections a month from a healthcare provider, for 12 doses, in postmenopausal women only, with a boxed warning on heart attack, stroke and cardiovascular death.2
| Tymlos | Evenity | |
|---|---|---|
| Drug | Abaloparatide, a PTHrP(1-34) analog1 | Romosozumab-aqqg, a sclerostin inhibitor2 |
| Who | Postmenopausal women and men with osteoporosis at high fracture risk1 | Postmenopausal women with osteoporosis at high fracture risk2 |
| Dose | 80 mcg under the skin of the belly once daily, self-injected1 | 210 mg monthly as two 105 mg injections, given by a healthcare provider2 |
| How long | Use for more than 2 years in a lifetime is not recommended1 | 12 monthly doses; an anti-resorptive medicine may follow2 |
| Common side effects | Dizziness 10% vs 6% on placebo; nausea 8% vs 3%; palpitations 5% vs 0.4%1 | Joint pain 13.1% vs 12.1% on placebo; headache 6.6% vs 5.8%2 |
| Missed dose | Take it later that day; never 2 injections in one day1 | Give as soon as it can be rescheduled, then monthly from that date2 |
| Boxed warning | None1 | WARNING: POTENTIAL RISK OF MYOCARDIAL INFARCTION, STROKE AND CARDIOVASCULAR DEATH2 |
Evenity is not started within a year of a heart attack or stroke. In its trial against alendronate, major heart events were 2.0% on Evenity vs 1.1%; against placebo they were 0.8% in each group.2 Tymlos can drop blood pressure on standing, usually within 4 hours of a dose, so the first several doses are given sitting or lying down. Abaloparatide caused bone cancer (osteosarcoma) in rats; whether it does in people is unknown.1
Evenity also warns of jaw bone death and unusual thigh fractures, and needs low calcium corrected first; Tymlos warns of high blood and urine calcium.21 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Tymlos side effects, Evenity side effects, the Tymlos and Evenity dosing schedules, the Tymlos and Evenity missed-dose pages, the abaloparatide and romosozumab guides, and Evenity vs Forteo: how do the two bone-building drugs compare?.