Bone turnover markers (CTX and P1NP): do you have a baseline?

I really don't care what McCormick recommends.

mayblin,
this was such a genius idea. You might have to introduce it again because I was disappointed to see so few numbers. Mine:
The legend declines a normal for either
CTX
294 pg/mL 3/24/23
438 pg/mL 7/19/23
457 pg/mL 8/22/23
P1NP
67 mcg/L 3/24/23
73mcg/L 7/19/23
75mcg/L 8/22/23
Was I low on osteoclasts initially? Or do you see this as a usual trend. Did I miss the initial P1NP high.

thanks for your set of btms results, @gently !

First question came to mind is: for your baseline testing, did you have the controllable variables under control? Most of us went for bone marker testing for the first time knowing nothing about optimal timing, fasting etc. Some of those factors could be well managed for a more accurate results.

I truly wished I had the baseline bone markers for future references. The one and only opportunity in the therapy journey - treatment naive state - is forever lost.

I never knew about the CTX blood test until I read about it on this site. I went to my bloodwork and looked at the trends and the numbers. My endocrinologist failed to mention this test and it does seem to be important. I am 67 years old my osteo numbers have gotten better because I am doing bio, identical, hormones, resistance, training, vitamins, etc., my CTX number now stands at 300. The norms on the blood test say anything above 1300 is considered a significant bone turnover am very new to this. If there’s anything you could shed light on I would appreciate it. I looked at my trends over the last 10 years, and they have dropped significantly , the highest was 810 years ago and now 300. They wanted to put me on Polea 10 years ago and I refused that’s when I really ramped up exercise Pilates, vitamins, and my nutrition. Two years ago I went on for two months and had such horrific side effects. I said never again I wound up fainting etc. it was a nightmare, any information on this I would greatly appreciate. I did ask my integrative medicine doctor to also include the P1NP for my bloodwork this month. Thank you for anybody that knows anything about this

Sorry I went on actonel with great regrets!

Mayblin, thanks for looking at the bone markers.
I ran five miles just prior to my labs which were at 7am. Probably raising both numbers. Other variables were controlled.
My base numbers look kind of good to me. Can you speculate?

It seems to me that if there were some magical ideal bone marker values. those would be well known and any practioner worth consulting would know them. It is an interesting exercise to share our baseline numbers and I have done so. However, if my understanding is correct, my baseline numbers are in the range McCormick likes to see. Does that mean I don't have osteoporosis although my DEXA says I do? Or maybe it means I have stabilized. Or maybe the values have very limited meaning.

@normahorn you brought up a great point! Bone turnover markers are far from perfect as diagnostic or therapeutic aids. However, since Dexa is pretty much the only gold standard for estimating our bone health - density here, we could use bone markers for a ‘peak’ into the state of our bone tunnover. Moreover, Dexa is usually done annually or biannually to see any significant changes of bone density. To some, that’s torturously long. Why would one spend $$$ in therapy, consultations but not couple of bone markers to monitor?

You baseline is interesting to say the least. Your btms are not telling us an overt high turnover state. It will be nice to know your Dexa changes over the years if you have. Your family history will shed some lights as to your susceptibility to op genetically. A good clinician will combine all the factors together, not just by looking at your Dexa, to make a judgement or decision about the probable cause of your osteopenia/osteoporosis, and proceed to treatment if necessary.

After reading a bit about CLL, my uneducated thinking is: would CLL causing disturbances of monocytes/macrophage lineage differentiating to osteoclast precursors? Osteoblasts also originate from mesenchymal stem cells from bone marrow. If CLL affects any of those cell differentiation, bone remodeling will be affected and your btms might appear to be alright but your bone quality/density may be affected. My two cents

Nme1985,
I didn't know about CTX prior to getting bloodwork before starting Evenity. I asked the nurse if I needed to fast. She said no. I had the bloodwork done about 10 am. My CTX was 262. There was no P1NP that was ordered. The remaining markers for kidney, liver, inflammation wre WNL. My Dexa was -2,8 lumbar and -2,0 hip. I had previously been on Actonel for 10 years before the FDA came out with warnings about duration of treatment. I was off it for about 9 years before my last DEXA so I should have had a whole new skeleton. I plan to ask for P1NP in addition to a FASTING CTX. It's unfortunate that patients have to do this level of research in order to get the care that we deserve.

I totally agree with you. I was only on the actonel for two months. Your ctx number was great! I am praying my numbers stay the same or improve. Good luck! You have been so helpful as well as others thank you so much