With a low baseline CTX would an antiresorptive be contraindicated?
Does the pharmaceutical choice determine the frequency of bone marker testing? Mayblin?
Sorry that was careless! Yes CTX was low at 145 after one month Evenity, low but in range at 183 in the middle of the 3rd month. Before any treatment w/Tymlos it was 324 though that was an hour later and not fasting like the other ones. Reference range was 152-858 for over 70 years old.
Somewhere around 16-18 months of Tymlos it was 165 then 186.
Sorry that was careless! Yes CTX was low at 145 after one month Evenity, low but in range at 183 in the middle of the 3rd month. Before any treatment w/Tymlos it was 324 though that was an hour later and not fasting like the other ones. Reference range was 152-858 for over 70 years old.
Somewhere around 16-18 months of Tymlos it was 165 then 186.
My P1NP was 54 pre-treatment. After 16-18 months Tymlos it was 40, then 35. After one month Evenity, 33, and in the middle of the 3rdmonth 39. Very disappointing for Evenity. For the Tymlos numbers, the testing may have missed the high point at a year or so.
DEXA's spine 6/21 -3.7 4/23 -2.5 (20% gain after 18 months Tymlos)
hip -3.3 -2.9 (9% gain)
femur neck -4.1 -3.6 (the reason I did some Evenity)
My P1NP was 54 pre-treatment. After 16-18 months Tymlos it was 40, then 35. After one month Evenity, 33, and in the middle of the 3rdmonth 39. Very disappointing for Evenity. For the Tymlos numbers, the testing may have missed the high point at a year or so.
DEXA's spine 6/21 -3.7 4/23 -2.5 (20% gain after 18 months Tymlos)
hip -3.3 -2.9 (9% gain)
femur neck -4.1 -3.6 (the reason I did some Evenity)
@windyshores, Your baseline CTX may not be accurate due to blood collecting time and morning food. According to what is known about circadian and food effects on CTX, your baseline CTX might have been higher than 324. Also it didn’t appear that you had btms tested during anabolic phase of tymlos so the btms at 16-18mo of tymlos might be at the tail end of therapy. These might explain your earlier btm results? Wish you had btms tested at 3, or6 or 12 mo of tymlos. Despite all this, you had such a wonderful Dexa results, a true success story of tymlos! Then your btms readings during evenity is most perplexing. No pattern for CTX, or P1NP. Please keep us posted of your next Dexa if you could. It will be interesting to see how it comes out.
dna41, so you are close to 6 months after your final dose of Prolia. Reclast is the widely recommended drug to follow. And to my thinking the most logical. You took Prolia to lower the CTX and are following with Reclast to fight rebound from Prolia. Instead of collecting preosteoclasts, Reclast with cause the osteoclasts to die and will prevent cells from differentiating into preosteoclasts. Additional protection will come from reclast actually cladding the bone, preventing osteoclasts from attaching to bone.
I'm copying a helpful note from the md who led the trials on Reclast in case you haven't seen it.
"My strong recommendation based on my knowledge of bisphosphonates (given that I helped to develop three of them, and treated 13,000 patients in phase 3 trials with them) is to have the infusion center dilute the 5 mg of zoledronic that comes in 100 mL of D5W into 500 mL of NS, and infuse the endodoc recnow 600 mL over 60 minutes. Making the drug more dilute and administering it more slowly significantly improves the renal safety for N-containing bisphosphonates.I also strongly recommend that the infusion nurses give the patient 650 mg of acetaminophen (Tylenol) at the time of the infusion, and that the patient take that same dose with dinner and at bedtime the day of the infusion, with all 3 meals and at bedtime the day after the infusion, and a final (7th) dose of acetaminophen with breakfast the 2nd morning after the infusion. These 8 doses total of Tylenol reduce the chance of a symptomatic APR (Acute Phase Reaction) from 22% to < 1%.Best, Endodoc"
@windyshores, Your baseline CTX may not be accurate due to blood collecting time and morning food. According to what is known about circadian and food effects on CTX, your baseline CTX might have been higher than 324. Also it didn’t appear that you had btms tested during anabolic phase of tymlos so the btms at 16-18mo of tymlos might be at the tail end of therapy. These might explain your earlier btm results? Wish you had btms tested at 3, or6 or 12 mo of tymlos. Despite all this, you had such a wonderful Dexa results, a true success story of tymlos! Then your btms readings during evenity is most perplexing. No pattern for CTX, or P1NP. Please keep us posted of your next Dexa if you could. It will be interesting to see how it comes out.
@mayblin yes exactly. As I said, the 324 was not fasting and was 10:30, the others were 9:30. I don't have any useful bone markers for baseline or Tymlos, and the Evenity ones are puzzling. If I had better P1NP with Evenity it might motivate me to keep going though not sure I can anyway.
I have actually been on Prolia several years. I am currently getting ready for Reclast, thus the bone markers. I am trying to get clarification on these tests since they are listed in a different format in my tests results.
@dna41 i see now. If 74 is your CTX after years of prolia, then this is not surprising being low. Please keep posting after you get clarification if you could.
Testing bone turnover markers especially CTX during prolia withdrawal is a great idea if not a must. How often do you and your endo plan to test bone markers?
@dna41 i see now. If 74 is your CTX after years of prolia, then this is not surprising being low. Please keep posting after you get clarification if you could.
Testing bone turnover markers especially CTX during prolia withdrawal is a great idea if not a must. How often do you and your endo plan to test bone markers?
I was able to confirm that CTX is 74. Also, I was told my endo did not do P1NP. I believed I was having both so I am disappointed. I should be having Reclast in about a week.
I was able to confirm that CTX is 74. Also, I was told my endo did not do P1NP. I believed I was having both so I am disappointed. I should be having Reclast in about a week.
Some endo don’t do P1NP when it comes to antiresorptives, especially powerful ones like Reclast or prolia. When your CTX is low at 74, most likely your P1NP is very low too so keep monitoring CTX is sufficient.
If you like, I can send you the link for a published review regarding strategies in withdrawal of prolia. It mentioned btms and bmd monitoring during prolia withdrawal, meds and lenght of antiresorptive treatment. But it does seem you are in good hands.
Some endo don’t do P1NP when it comes to antiresorptives, especially powerful ones like Reclast or prolia. When your CTX is low at 74, most likely your P1NP is very low too so keep monitoring CTX is sufficient.
If you like, I can send you the link for a published review regarding strategies in withdrawal of prolia. It mentioned btms and bmd monitoring during prolia withdrawal, meds and lenght of antiresorptive treatment. But it does seem you are in good hands.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796169/#B23-jcm-10-00152
If it’s too long or too dry to read, skip to section 9 n 10 summary n conclusion. Section 8 worth reading. The body of the review explained mechanism of withdrawal phenomena and strategies well. Have some clinical data demonstrating results, and stated limitations.
If you’ve been on prolia long, frequent check of CTX looks like a must, first few months till you see CTX stabilizes, might take 24mo according to this paper. BMD monitoring a must.
Please keep us updated about your process. Wish a smooth and successful transition.
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Sorry that was careless! Yes CTX was low at 145 after one month Evenity, low but in range at 183 in the middle of the 3rd month. Before any treatment w/Tymlos it was 324 though that was an hour later and not fasting like the other ones. Reference range was 152-858 for over 70 years old.
Somewhere around 16-18 months of Tymlos it was 165 then 186.
My P1NP was 54 pre-treatment. After 16-18 months Tymlos it was 40, then 35. After one month Evenity, 33, and in the middle of the 3rdmonth 39. Very disappointing for Evenity. For the Tymlos numbers, the testing may have missed the high point at a year or so.
DEXA's spine 6/21 -3.7 4/23 -2.5 (20% gain after 18 months Tymlos)
hip -3.3 -2.9 (9% gain)
femur neck -4.1 -3.6 (the reason I did some Evenity)
@windyshores, Your baseline CTX may not be accurate due to blood collecting time and morning food. According to what is known about circadian and food effects on CTX, your baseline CTX might have been higher than 324. Also it didn’t appear that you had btms tested during anabolic phase of tymlos so the btms at 16-18mo of tymlos might be at the tail end of therapy. These might explain your earlier btm results? Wish you had btms tested at 3, or6 or 12 mo of tymlos. Despite all this, you had such a wonderful Dexa results, a true success story of tymlos! Then your btms readings during evenity is most perplexing. No pattern for CTX, or P1NP. Please keep us posted of your next Dexa if you could. It will be interesting to see how it comes out.
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Helpful -
Hug
1 Reactiondna41, so you are close to 6 months after your final dose of Prolia. Reclast is the widely recommended drug to follow. And to my thinking the most logical. You took Prolia to lower the CTX and are following with Reclast to fight rebound from Prolia. Instead of collecting preosteoclasts, Reclast with cause the osteoclasts to die and will prevent cells from differentiating into preosteoclasts. Additional protection will come from reclast actually cladding the bone, preventing osteoclasts from attaching to bone.
I'm copying a helpful note from the md who led the trials on Reclast in case you haven't seen it.
"My strong recommendation based on my knowledge of bisphosphonates (given that I helped to develop three of them, and treated 13,000 patients in phase 3 trials with them) is to have the infusion center dilute the 5 mg of zoledronic that comes in 100 mL of D5W into 500 mL of NS, and infuse the endodoc recnow 600 mL over 60 minutes. Making the drug more dilute and administering it more slowly significantly improves the renal safety for N-containing bisphosphonates.I also strongly recommend that the infusion nurses give the patient 650 mg of acetaminophen (Tylenol) at the time of the infusion, and that the patient take that same dose with dinner and at bedtime the day of the infusion, with all 3 meals and at bedtime the day after the infusion, and a final (7th) dose of acetaminophen with breakfast the 2nd morning after the infusion. These 8 doses total of Tylenol reduce the chance of a symptomatic APR (Acute Phase Reaction) from 22% to < 1%.Best, Endodoc"
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Hug
3 Reactions@mayblin yes exactly. As I said, the 324 was not fasting and was 10:30, the others were 9:30. I don't have any useful bone markers for baseline or Tymlos, and the Evenity ones are puzzling. If I had better P1NP with Evenity it might motivate me to keep going though not sure I can anyway.
@dna41 i see now. If 74 is your CTX after years of prolia, then this is not surprising being low. Please keep posting after you get clarification if you could.
Testing bone turnover markers especially CTX during prolia withdrawal is a great idea if not a must. How often do you and your endo plan to test bone markers?
Wish you a smooth transition!
I was able to confirm that CTX is 74. Also, I was told my endo did not do P1NP. I believed I was having both so I am disappointed. I should be having Reclast in about a week.
Some endo don’t do P1NP when it comes to antiresorptives, especially powerful ones like Reclast or prolia. When your CTX is low at 74, most likely your P1NP is very low too so keep monitoring CTX is sufficient.
If you like, I can send you the link for a published review regarding strategies in withdrawal of prolia. It mentioned btms and bmd monitoring during prolia withdrawal, meds and lenght of antiresorptive treatment. But it does seem you are in good hands.
-
Like -
Helpful -
Hug
3 ReactionsOh, thank you for that information. I would be happy to have that link you mentioned. I really appreciate your help!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796169/#B23-jcm-10-00152
If it’s too long or too dry to read, skip to section 9 n 10 summary n conclusion. Section 8 worth reading. The body of the review explained mechanism of withdrawal phenomena and strategies well. Have some clinical data demonstrating results, and stated limitations.
If you’ve been on prolia long, frequent check of CTX looks like a must, first few months till you see CTX stabilizes, might take 24mo according to this paper. BMD monitoring a must.
Please keep us updated about your process. Wish a smooth and successful transition.
-
Like -
Helpful -
Hug
4 Reactions