Atrial Fibrillation is NOT a Contraindication to Tymlos (Abaloparatide)
There is no evidence that atrial fibrillation represents a contraindication to Tymlos (abaloparatide), and you appear to be confusing Tymlos with romosozumab (Evenity). These are distinct osteoporosis medications with different cardiovascular safety profiles.
Critical Clarification
- Tymlos (abaloparatide) is a PTH analogue used for severe osteoporosis treatment
- Romosozumab (Evenity) is the sclerostin inhibitor that has raised cardiovascular safety concerns
- The question asks about Tymlos, but the cardiovascular concerns in the literature relate to romosozumab, not abaloparatide 1, 2, 3
Cardiovascular Considerations for PTH Analogues (Including Tymlos)
- Recent real-world data from 2025 comparing romosozumab to PTH analogues (teriparatide/abaloparatide) showed PTH analogues had comparable or potentially higher rates of major adverse cardiovascular events compared to romosozumab in propensity-matched cohorts 4
- However, this does not establish atrial fibrillation as a contraindication to PTH analogue therapy
- No specific contraindication exists for using Tymlos in patients with atrial fibrillation
Management Approach for Patients with Atrial Fibrillation
If prescribing Tymlos to a patient with atrial fibrillation:
- Ensure appropriate anticoagulation management per ACC/AHA guidelines, as antithrombotic therapy is recommended for all AF patients except those with lone AF or contraindications 5
- Target INR of 2.0-3.0 for patients on warfarin with nonvalvular atrial fibrillation 5
- Rate control should be achieved with beta-blockers or non-dihydropyridine calcium channel antagonists 5
Key Clinical Pitfall
Do not confuse romosozumab's cardiovascular warnings with Tymlos (abaloparatide). Romosozumab carries specific warnings about cardiovascular events and should not be used in patients with myocardial infarction or stroke within the preceding year 2, 3. This restriction does not apply to Tymlos.