Even 60 mcg would be good @drsufowler. I had great gains with 6-7, mostly 7 clicks for the last year.

My CTX and P1NP did not match expectations that I had given my 20% gain in spine and 9% gain in hip. But I had them done at 18 months. I stayed on Tymlos for another 6 months regardless. I was told bone quality would be improving even if bone growth had stopped and fracture risk would continue to go down.

I have become skeptical of these blood markers to be honest. They don't match expectations with Evenity either. One of my endos says they don't show what is going on in bone, and one uses them but with caution about their reliability. McCormick uses them but says they have to be done fasting (CTX does, P1NP not as much) and at the same time of day, early morning.

Also kidney disease may raise CTX.

It helps to have a reliable baseline. Unfortunately my baseline CTX was not fasting but I can at least go by the P1NP baseline! Oddly my P1NP was higher before any treatment. I am wondering if that is some kind of estrogen rebound after taking anti-estrogen meds for cancer and have to remember to ask doc!