1. < Osteoporosis & Bone Health

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

Posted by mayblin @mayblin, Mar 27 11:05am

Currently i am on forteo therapy with a couple bone markers tests done. However, I didnt have ctx or p1np tested before the start of forteo as a baseline, regrettably.

It is known that the CTX value varies greatly among different individuals, with a very wide range. For post menopausal women, the range could be 34 - 1037 pg/ml; while for perimenopausal women 34-635 pg/ml. Different labs also have a slight different range values.

CTX, a bone resorption (breakdown) marker, is heavily influenced by a number of factors, such as food intake, circadian variation and exercise/life style, etc.

Bone remodeling is a dynamic and complex process. CTX itself may not fully reveal the whole picture. The bone building marker P1NP, is a lot less influenced by external factors. Taking both into consideration at the same time may shed more lights than looking at CTX or P1NP alone.

For those who had their CTX and P1NP tested before treatment with a bone drug, could you share the results if you don't mind? Thanks a lot!

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

nme1985 | @nme1985 | Apr 14 9:02am
In reply to @gently "nme 1985, ctx measures a fragment of collagen that is removed by the bloodstream when the..." + (show)
@gently

nme 1985,
ctx measures a fragment of collagen that is removed by the bloodstream when the bones are being broken down. It is higher if you are healing a broken bone or if your bones are still growing Or if you have osteoporosis. 880 reflects greater bone breakdown than 350. Which is great if you've fractured or if your bones are growing.
Even so, if the P1NP is high you might still be replacing the bone equal or greater than the bone you are losing.
Bone turnover, though, is important (in addition to growing bone and healing bone) for remodeling bone. You need different bone alignment and strength for variant activities. So if you were to take up parachuting, your bones would breakdown and rebuild to proctect you from breakage in this activity.
Do you really have ten years of CTX. It would be interesting to look at in terms of age and bisphosphonate use, if you feel like entering them here.

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I only took Actonel for two months and had such bad side effects. I had to stop prior to that no meds I wound up sainting, etc. that’s why I have really focused on the bio identical, hormones and exercise, nutrition, etc. I am really at a loss when it comes to medication, trying my best to avoid them at all costs. I also have Osteo arthritis recently had the gel put in My right knee… I could hold off on knee replacement as long as I can. It’s bone on bone at this point. Any comments or input would be greatly appreciated. I love love this website.

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mayblin | @mayblin | Apr 14 2:45pm

While your initial jump of CTX is noticeable, I felt it doesn’t warrant reading too much into it, simply because jogging became a variable here. During initial phase of forteo treatment, increase in CTX is not a characteristic of the drug. When the time comes that you see a jump in P1NP reading, then you know you are in anabolic window. Yours may just be delayed a few months when compared with the statistics in clinical trials.

There must be a mastermind behind your therapy planning and careful monitoring, for few ppl had baseline and serial timed testings during anabolic therapy.

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1 reply
mayblin | @mayblin | Apr 14 4:50pm
In reply to @mayblin "While your initial jump of CTX is noticeable, I felt it doesn’t warrant reading too much..." + (show)
@mayblin

While your initial jump of CTX is noticeable, I felt it doesn’t warrant reading too much into it, simply because jogging became a variable here. During initial phase of forteo treatment, increase in CTX is not a characteristic of the drug. When the time comes that you see a jump in P1NP reading, then you know you are in anabolic window. Yours may just be delayed a few months when compared with the statistics in clinical trials.

There must be a mastermind behind your therapy planning and careful monitoring, for few ppl had baseline and serial timed testings during anabolic therapy.

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This comment meant for @gently

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kristie2 | @kristie2 | Apr 15 9:41am

Hi, before I started Evenity my CTX was 933 and my P1NP was 77 and yes these were fasting before 8am and no biotin, collagen or calcium supplements 3 days prior .
After 4 months my new numbers were CTX 316 and P1NP was 67 .

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2 replies
Michael Lavacot | @michaellavacot | Apr 15 10:44am
In reply to @mayblin "Hi @michaellavacot, thank you very much for your reply and sharing your treatment information. To me,..." + (show)
@mayblin

Hi @michaellavacot, thank you very much for your reply and sharing your treatment information. To me, your baseline btms showed a very high resorption rate, while p1np is alright. Do you have a known secondary cause for the high resorption rate, may I ask?

Although you had one set of btms during evenity treatment, the changes in both p1np and ctx fell in expection when compared to what manufacturer stated. Did you have a good gain in dexa after 1 year evenity?

Looks like you and your doctor decided on prolia to follow evenity, as Amgen suggested.

Thanks again!

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Hi mayblin, I believe I have high baseline CTX from my hypercalciuria. I'm was peeing out more calcium than I could absorb in a day. While I have lowered urine calcium, it's still way to high at about 350mg/day. I'm still trying to track down the cause. Hopefully this year I will be able to figure it out.

I did not have good outcomes on Evenity. I gained only about 2%. I believe that the results are again related to my high urine calcium. You can't build bone if your net daily calcium is near or below zero.

Prolia seemed like the right choice if not the only choice after Evenity for me. Fingers crossed I can tilt the calcium balance in my favor and see some improvements. I'm taking in about 1500mg or more calcium per day.

Thanks for asking. I have appointment this year with the best nephologist and endocrinologist I could find. They should be able to help me more.

Mike

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2 replies
Michael Lavacot | @michaellavacot | Apr 15 10:54am
In reply to @gently "Interesting drop in P1NP after initiation of Prolia. Supports that suspicion that if Evenity becomes antiresorptive..." + (show)
@gently

Interesting drop in P1NP after initiation of Prolia. Supports that suspicion that if Evenity becomes antiresorptive for a longer period than it is anabolic, Prolia might not be the best follow-up medication.

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The bone markers while on Evenity were spot on to the trials. Below is a snapshot. While CTX is lowered on Evenity, it is not near as low as on Prolia.

Since my T-scores are still very poor, my only choice after Evenity was Prolia. A bisphosphonate would not be able to get me into a safe zone and I really don't think Tymlos or Forteo would work out for me. That said, I am considering combination Prolia + Tymlos. I will wait a year to see how Prolia is doing on its own first.
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mayblin | @mayblin | Apr 15 11:52am
In reply to @kristie2 "Hi, before I started Evenity my CTX was 933 and my P1NP was 77 and yes..." + (show)
@kristie2

Hi, before I started Evenity my CTX was 933 and my P1NP was 77 and yes these were fasting before 8am and no biotin, collagen or calcium supplements 3 days prior .
After 4 months my new numbers were CTX 316 and P1NP was 67 .

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Hi @kristie2 do you happen to have your bone markers tested between 2weeks - 3 months of evenity therapy?

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1 reply
kristie2 | @kristie2 | Apr 15 11:58am
In reply to @mayblin "Hi @kristie2 do you happen to have your bone markers tested between 2weeks - 3 months..." + (show)
@mayblin

Hi @kristie2 do you happen to have your bone markers tested between 2weeks - 3 months of evenity therapy?

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I don’t have that graph that you have but the numbers I gave you were prior to starting and then 4 months after being on Evenity .

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bluebonnet242 | @bluebonnet242 | Apr 15 4:05pm

@mayblin what is the best way to prepare for CTC and P1NP. I know I need to fasting and to go early in the morning. Do I need to be off supplements the day before? Other tips or instructions?

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3 replies
mayblin | @mayblin | Apr 15 4:37pm
In reply to @bluebonnet242 "@mayblin what is the best way to prepare for CTC and P1NP. I know I need..." + (show)
@bluebonnet242

@mayblin what is the best way to prepare for CTC and P1NP. I know I need to fasting and to go early in the morning. Do I need to be off supplements the day before? Other tips or instructions?

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I’ll post the factors that will affect CTX and P1NP when I got time as I’m on a road trip right now.

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