Are evenity and Tymlos the same? Unpacking the Differences in Osteoporosis Medications

October 9, 2025 •

4 min read

According to the National Osteoporosis Foundation, approximately 10 million Americans have osteoporosis, a condition that makes bones brittle and prone to fracture. While both Evenity and Tymlos are powerful anabolic drugs designed to treat this condition, the answer to "Are evenity and Tymlos the same?" is a definitive no, as they function via different mechanisms and have distinct risk profiles.

Quick Summary

Evenity (romosozumab) and Tymlos (abaloparatide) are anabolic osteoporosis medications that differ in their mechanisms of action, administration, and potential risks. Evenity increases bone formation and decreases bone resorption, while Tymlos primarily promotes bone formation. Their distinct drug classes and administration schedules necessitate careful medical evaluation before prescribing.

Key Points

Distinct Mechanisms: Evenity is a sclerostin inhibitor with a dual effect on bone, while Tymlos is a PTHrP analog that primarily builds new bone.
Different Dosing: Evenity is a once-monthly injection, whereas Tymlos requires a daily injection.
Varying Durations: Evenity treatment lasts for 12 months, while Tymlos can be used for up to 24 months.
Unique Risk Profiles: Evenity carries a boxed warning for cardiovascular events, while Tymlos is associated with a risk of orthostatic hypotension and tachycardia.
Mandatory Follow-Up: Both Evenity and Tymlos require subsequent therapy with an anti-resorptive medication to maintain bone mass gains.
Personalized Decisions: The choice between Evenity and Tymlos depends on a patient’s individual health history, fracture risk factors, and tolerance for different administration schedules.

Understanding Anabolic Osteoporosis Treatments

Osteoporosis is characterized by low bone mass and structural deterioration of bone tissue, leading to an increased risk of fractures. For individuals at high risk, anabolic medications are a primary treatment option because they actively build new bone, rather than just slowing down bone loss like antiresorptive therapies. Among the potent anabolic options are Evenity (romosozumab) and Tymlos (abaloparatide). Although both build bone, they are fundamentally different drugs with unique pharmacological properties, administration requirements, and safety considerations.

What is Evenity? (Romosozumab)

Evenity, with the generic name romosozumab, is a humanized monoclonal antibody that targets and inhibits a protein called sclerostin. Sclerostin naturally limits bone formation and promotes bone breakdown. By blocking sclerostin, Evenity achieves a dual effect:

It rapidly increases bone formation by stimulating osteoblast activity.
It reduces bone resorption, or breakdown, by decreasing osteoclast activity.

This dual action makes Evenity a unique therapy option for postmenopausal women with severe osteoporosis at high risk of fracture. Treatment with Evenity is limited to a single 12-month course, administered as two consecutive subcutaneous injections (210 mg total) once per month, usually by a healthcare provider.

Potential Risks and Side Effects of Evenity

Evenity carries a boxed warning from the U.S. Food and Drug Administration (FDA) regarding an increased risk of cardiovascular events, including heart attack, stroke, and cardiovascular death. Because of this risk, Evenity should not be initiated in patients who have had a heart attack or stroke in the preceding year. Other common side effects include joint pain, headaches, and nasopharyngitis (common cold). After the 12-month treatment course, patients must transition to an antiresorptive medication, such as a bisphosphonate or denosumab, to maintain the bone mineral density gains.

What is Tymlos? (Abaloparatide)

Tymlos, known generically as abaloparatide, is an analog of human parathyroid hormone-related protein (PTHrP). It functions as an anabolic agent by activating the PTH1 receptor, which stimulates osteoblasts to form new bone. Unlike Evenity's dual action, Tymlos primarily focuses on promoting bone formation. Tymlos is typically prescribed for postmenopausal women with osteoporosis at high risk of fracture.

Potential Risks and Side Effects of Tymlos

Tymlos has a treatment duration of up to two years and is self-administered as a daily subcutaneous injection using a prefilled pen. A black box warning is associated with the drug regarding osteosarcoma, a type of bone cancer, based on animal studies. In humans, this risk has not been confirmed. Notable side effects associated with Tymlos include:

Orthostatic hypotension (a drop in blood pressure when standing up)
Headaches
Heart palpitations and increased heart rate
Dizziness and nausea

Similar to Evenity, completing a course of Tymlos therapy requires follow-up treatment with an antiresorptive agent to prevent bone mineral density loss.

Key Differences Between Evenity and Tymlos

Mechanism of Action: Evenity has a dual effect, blocking sclerostin to increase bone formation and decrease bone resorption. Tymlos is primarily an anabolic agent, activating the PTH1 receptor to build new bone.
Dosing Schedule: Evenity is a once-monthly injection, while Tymlos is a daily injection.
Treatment Duration: Evenity treatment is limited to 12 consecutive months. Tymlos can be used for up to 24 months.
Side Effect Profile: Evenity carries a specific boxed warning for cardiovascular events like heart attack and stroke. Tymlos is associated with a risk of orthostatic hypotension and an increase in heart rate. Both are associated with a potential risk of osteosarcoma (based on animal studies) and osteonecrosis of the jaw.
Targeted Efficacy: Some studies suggest that Evenity may offer better bone density increases in the hip, while Tymlos may show a stronger effect on the spine. This is a consideration for personalized treatment.
Self-Administration: Tymlos is a daily self-injection, whereas Evenity is a monthly injection administered by a healthcare professional.

Evenity vs. Tymlos: A Comparison Table


Feature	Evenity (romosozumab)	Tymlos (abaloparatide)
Drug Class	Sclerostin Inhibitor (Monoclonal Antibody)	Parathyroid Hormone-Related Peptide (PTHrP) Analog
Mechanism	Dual effect: Increases bone formation and decreases bone resorption	Primarily anabolic: Increases bone formation
Dosage	210 mg via two subcutaneous injections, once monthly	80 mcg via one subcutaneous injection, once daily
Duration	12 months only	Up to 24 months
Administration	Administered by a healthcare provider	Self-administered via a prefilled pen
Key Risks	Boxed warning for increased cardiovascular events (heart attack, stroke)	Boxed warning for osteosarcoma (based on animal studies); risk of orthostatic hypotension
Post-Treatment	Requires an anti-resorptive agent to maintain bone mass	Requires an anti-resorptive agent to maintain bone mass

Conclusion

The question "Are evenity and Tymlos the same?" is answered by their distinct pharmacological identities. While both are used to treat severe osteoporosis by building bone, Evenity is a monoclonal antibody with a dual mechanism, a monthly dosing schedule for 12 months, and a cardiovascular risk warning. Tymlos is a PTHrP analog that primarily promotes bone formation, is administered daily for up to 24 months, and has a risk of orthostatic hypotension. The choice between Evenity and Tymlos depends on a patient's individual health profile, specific fracture risks, cardiovascular history, and tolerance for daily versus monthly injections. Patients must discuss these differences with their healthcare providers to determine the most appropriate treatment plan and always follow up with antiresorptive therapy to preserve the hard-won bone density gains. A thorough medical evaluation is critical for making an informed decision. For further information, the Drugs.com comparison tool offers an overview of differences.

Frequently Asked Questions

Evenity works by blocking sclerostin, a protein that stops bone formation, leading to a dual effect that increases new bone formation and decreases bone resorption. Tymlos, in contrast, is an analog of a parathyroid hormone-related protein (PTHrP) that directly stimulates osteoblasts to build new bone, focusing primarily on the formation process.

Evenity is administered as two subcutaneous injections once per month for 12 months, and this must be done by a healthcare provider. Tymlos is a daily self-injection that patients administer at home using a prefilled pen for up to 24 months.

Sequential therapy, such as taking Tymlos after completing an Evenity regimen, is not typically recommended. After completing either Evenity or Tymlos, a different class of medication, an anti-resorptive agent like a bisphosphonate, is generally prescribed to maintain the newly built bone.

Yes, both medications have safety warnings. Evenity has a boxed warning for an increased risk of heart attack, stroke, and cardiovascular death. Tymlos has a boxed warning for osteosarcoma, a type of bone cancer, based on animal studies.

Common side effects for Evenity include joint pain, headaches, and nasopharyngitis. Tymlos is frequently associated with headaches, dizziness, and orthostatic hypotension (a drop in blood pressure when standing).

Some anecdotal and clinical evidence suggests that Evenity may be more effective at improving bone density in the hip, while Tymlos may show a slightly more pronounced effect on the spine.

Physicians consider several factors, including the patient's specific fracture risk, medical history (especially cardiovascular health for Evenity), comfort with daily versus monthly injections, and specific bone density results. A careful, personalized medical evaluation is always necessary.