Hi formisc - Yes, the standard range for PTH is 15-65 pg/mL, however, it will go higher and even out of range when your body has a low calcium level. This is the signal to your bone, kidneys, and intestines to gather more calcium into your blood. My last blood test where my calcium dropped to 8.7 (normally around 9.5), my PTH jumped to 70 (normally 45). So I increased my calcium to get it back up. Prolia (or bisphosphonates) can make it tough for your body to get calcium from your bones when it needs it, which is good for bones, but bad for your bodies ability to control calcium without adequate diet calcium.

Now let's talk about calcium intake and supplements. I'm actually working on a presentation for next month on Calcium and Vitamin D for Osteoporosis for Bone Buddies. Calcium is a sensitive subject because there is a lot or religious beliefs surrounding types of calcium.

First, calcium intake. Dr. Fred Coe, who is recognized by many doctors as the worlds best nephrologist, did a study showing the average normal person needs ~700mg of calcium just to break even on bone balance. If you have elevated urine calcium, it's REALLY tough to get enough calcium to get to bone balance. If you cannot get to bone balance, you will lose bone, full stop. The body cannot manufacture calcium, it has to come from your diet or bones. Below is a draft slide from my presentation that shows the study outcome. I'm actually not surprised you did not gain much bone mass on Prolia if you were not getting adequate calcium.

Second, calcium supplements. Now I know I'm going to get pushback here, but calcium is calcium. When you take a calcium supplement like calcium citrate, calcium carbonate, calcium phosphate (hydroxyapatite) or others, it will be broken down into it's components before it is absorbed from the intestine into the blood stream. Calcium Ion (aka "free calcium") is what will be absorbed into the bloodstream. Now if you're low in some other mineral, then for convenience, you could take calcium with magnesium or vitamin D or whatever. They do not have to be taken at the same time. As long as your blood levels of magnesium or vitamin D are good, you don't need to take them with calcium. Here is a link to Dr. Bilezikian outlining this point https://youtu.be/fTEvmkxTG1g?si=ZRA0kKLlJ3kmdPb1 . Watch for two slides. I will have more details to share next month on calcium and vitamin D. It's too hard to put it all it text on a message board so you will have to wait for the video 🙂

Finally the disclaimer. I'm not a doctor, I'm a researcher trying to help others, based on my experience, be better prepared to talk to their doctors. While you should ensure your doctor is up to speed on current research, never take some random persons position over your doctors. It's just too risky.