@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

We have to be our own advocates! I also find myself researching etc. my endro and my last endro only push meds. No mention of exercise, diet, resistance training. It is disheartening to say the least. I will do all I can to not take meds. 🙏

Bone markers are ephemeral.
"Human bone is continuously remodeled through a process of bone formation and resorption. Approximately 90% of theorganic matrix of bone is type I collagen, a helical protein that is crosslinked at the N- and C-terminal ends of the molecule. During bone resorption, osteoclasts secrete a mixture of acid and neutral proteases that degrade the collagenfibrils into molecular fragments, including C-terminal telopeptide (CTx). As bone ages, the alpha form of aspartic acid present in CTx converts to the beta form. Beta-CTx is released into the bloodstream during bone resorption and servesas a specific marker for the degradation of mature type I collagen."

So we measure something very specific that is limited to a short point in time.
Markers can vary (time of day, calcium, biotin, collagen intake, circadium rhythm, exercise) but they precicely measure one aspect of bone morphology. Only one well two with P1NP. Many other things can go wrong along the way to a strong bone.
Are you tickling all of us with references to magical thinking and McCormick.
I've found that all of the practitioners interested in bone morphology are ordering bone markers. And we know that all practitioners are not worth consulting. But the use of bone markers is a science advancing with the development of accurate measurement. It may be that trying to compare CTX with P1Np should be done with different time of day on each and it may be that comparing the two is a fools quest. But doesn't it make ( a sort of common) sense?