Recently diagnosed with severe osteoporosis of lumbar spine -3.4 T sco

"Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology that evaluates the bone status at axial skeletal sites by analyzing raw ultrasound signals."

Very hard to come by. I've seen them available in the Chicago area, NJ, NC and MA.

I only have p1np at 13 mo, which was 400, then was tested again at 17mo for both ctx (910) and p1np (200). The baseline wasn't tested and I won't have it ever (lost opportunity). Tentatively I will be tested for both markers every 3 mo going forward. This frequency maynot be necessary but i like it. It is said if one is to take forteo/teriparatide, it's best to get at least p1np tested at 3-6 mo after the start of forteo to ensure the drug is working. Some insurances may not pay for bone markers even if you have your doctor's order. You will know after your first test. If insurance covers btms, I don't understand why doctor won't write the order if a patient requests them, although interpretation of tests is another matter.

Get a dexa with a tbs is a good idea. You might have to call radio,ogy dept directly. My results 13mo post forteo isn't remarkable. But I was comforted by my tbs improvements to the bottom of the normal range, whatever it might mean. And it's important to stick with the same dexa machine or facility from this point on for future comparison. Not sure if many ppl get scanned for the forearm, I did read some ppl's forearm t scores reduced after the therapy. Not sure the significance for it. But I'd prefer to have a stronger spine and femur/hip than a stronger forearm personally. There was a MD, whose mom has op and fell, broke her arm. The MD was glad that she didn't break hip/femur. I felt the same, although we don't have a choice when we fall.

100% agree with @windyshores : bone markers are not magical solutions, neither can they offer a solid base for our decision yet (but who knows how it might evolve in the future)? The usage of them entirely is up to you and your doctor. In the end dexa is still the golden standard for now. Our ultimate goal is to try our best not to frature.

@windyshores it seemed like you might be a (btm) non-responder to anabolics. Dr. P Miller mentioned he came across a few ppl like you but turned out they had great improvemnts with their dexas. My btms is out of normal range yet bmd increases are not reflecting correspondingly.

"we are all looking for certainty and there isn't any!", hope someday we have one!

@lynn59, Make sure your family doctor says the tests are "medically necessary" or they may not be covered.

Sounds so familiar with my endocrinologist. She said to take the injection for 2 years and repeat a dexa scan after. I was lucky enough to see a functional medicine aprn that although she is not an osteoporosis specialist, she has ordered various tests including the bone markers. I have an upcoming appointment with Dr. McCormick in May. Don't get discouraged because you have to keep trying and get a 2nd opinion with another endocrinologist. I just made an appointment with UCONN Osteoporosis center but that's in July. In the meantime, perhaps your family doctor can send a referral to another endocrinologist? That's what I did because you have to be your own health advocate. Sounds like you are doing that but keep up and don't let your endocrinologist rule you and even ignore you. They should be working for you!

Hi doglover1962. It’s such a shame that we are put on such a spinning wheel, but yes, I am on a wait list to see another endocrinologist, plus I’m migrating to a new DEXA machine at a different location that has TBS score capability. I’m getting my baseline DEXA on this new machine on April 9, two days before I get my first teriparatide injection. My family doctor is ordering baseline blood work for me. I need to find out what I should include. I was thinking CTX and P1NP … but reading your post on calcium loss, I was wondering what baseline measures you did and what measures will test again 3 months later?

lynn59, if you haven't already, it may be a good idea to do a 24hr urine calcium to make sure you are not losing calcium via kidney.

As for btms, idk how it works for Canada. In US, if one were to pay outpocket, we could bypass doctor and order online directly. When the tests are on sale, which happens very frequently, they are about 20-25% off, our pocket still hurts though.

Hi doglover1962. It’s such a shame that we are put on such a spinning wheel, but yes, I am on a wait list to see another endocrinologist, plus I’m migrating to a new DEXA machine at a different location that has TBS score capability. I’m getting my baseline DEXA on this new machine on April 9, two days before I get my first teriparatide injection. My family doctor is ordering baseline blood work for me. I need to find out what I should include. I was thinking CTX and P1NP … but reading your post on calcium loss, I was wondering what baseline measures you did and what measures will test again 3 months later?