Initial blood tests to ask for ?

For information I suggest "Great Bones" by Keith McCormick and Combinations and Sequencing on YouTube by Dr. Ben Leder.

Hi @windyshores I read that for evenity, the steady state is reached at 3 mo. There was a phase 1 study showed that at end of 3mo, the bone marker p1np showed increase. Also at the end of 3mo, bmd increased 5.3% in L spine and 2.3% at total hip with statistical significance in 785 subjects. You will have a few more shots, right? Your p1np might show a change after 3 mo.

@mayblin I would like to see that study. Dr. Leder's chart in his video shows the highest P1NP during the first month. I have done one set of two injections, and one injection for the second month. Next appointment is next week.

Is getting a baseline important in addition to when the treatment is peaking? Thanks.

@windyshores here it is:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809324/#:~:text=Romosozumab%20exhibits%20nonlinear%20pharmacokinetics.,relative%20to%20the%20given%20dose.
This is not an article for phase I study per se, rather, a summary or a review of evenity's clinical findings from various trials. The numbers that I quoted are in table 2, top line. The other phase I size is very small. You may find the remaining summary, especially 2 bigger phase III data useful to you too.

Yes these are among the first studies I read some time ago. Testing of P1Np happened at different points. Here is what I was referring to, that appears in Ledr's video:

"All doses increased bone formation marker P1NP and decreased bone resorption marker sCTx at week 1, compared with placebo"

The point I was making was not about BMD. It was about P1NP and how it peaks early on, in the first weeks, and then goes down, as does CTX.

@babs10 yes a baseline would be useful! CTX needs to be fasting, early and at consistent times. P1NP does not need to be fasting but good to do at the same time.

I haven't watched Leder's video. If he has a monthly p1np charting, you could just go by that. It seems that evenity has a non-linear pharmacokinetics. Combined with individual variation in respond to evenity, peak p1np might be hard to 'catch' during first 3 months period. In addition, the assumption that p1np peaks at the same time as Cmax has to be made. But, if Leder shows p1np pattern, I think you could apply his method to time your blood drawing.

I posted because my doc said to test it on day 14. I had a P1NP at day 30 that was disappointing. I already have guidance from MD and was just sharing what I learned 🙂 Leder's chart simplifies it by month and my doc was more specific about testing at peak time, day 14 (or 12). I was sharing this info with others.

Hi windy you know you are in great hands no matter what! Your shared experiences are very valuable to countless people. I'm grateful to have these first hand information and sure many others do too.

There are times I ponder the true value of bone markers during therapy and felt for most part they give the assurance of a drug that is working, not so much if a patient is not a responder. In my case im a high responder with an average dexa results. Of course btms have other uses especially as a baseline before any therapies. My curiosity also takes over with a newer drug like evenity. So thank you so much for sharing and best wishes for your continued success!

I am not sure about their usefulness either. My P1NP has not matched the level of effectiveness of Tymlos and I am still exploring the effect of Evenity. I have one doc who doesn't do the tests, one who does, and McCormick relies on them a lot but in other matters, all three disagree on some things!

There is no magic answer for us and we are all doing the best we can!