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rajmayo22, it's a really good idea to get the bone markers. CTX is most useful for determining bisphosphonate use. Tymlos doesn't raise osteoclasts (CTX) in the way that Forteo does. A low CTX would encourage the provider to extend Tymlos use rather than starting Fosamax. Significantly, too would be the second CTX after a month or two of Fosamax to determine it the medication is benefitting your bones. The risks with Fosamax are small. But why take a med that is all risk and no gain.
I recommend P1NP as well. Though there isn't controlled clinical data, more thinking phsicians, or physicians (and patients) who are thinking are considering the balance between CTX and P1NP to determine best levels of CTX.
Information from your bone markers would benefit your treatment plan. And mine, if you post them.
Replies to "rajmayo22, it's a really good idea to get the bone markers. CTX is most useful for..."
CTx on it's own can be deceiving. For example, my January CTx was 115. After my third Evenity injection it went up to 355. If I hadn't had my P1NP to compare to, I would have thought that my treatment wasn't working. That couldn't be further from reality.
Comparison of the ratios of P1NP to CTx shows that my bone turnover improved dramatically. The P1NP went up so much, that it more than negated the increase in CTx.
When looking at these ratios and the following equation, you don't need to take into account that the unit of measurement given for CTx (pg/mL) is not the same as that for P1NP (ng/mL). When comparing ratios, that's not relevant.
Here are my scores and ratios for comparison:
Jan 2024
*P1NP=11*
*CTx=115*
The ratio was approximately 1 P1NP to 10 CTx.
This means that the CTx number was 10 times higher than the P1NP number.
April 2024
*P1NP=102*
*CTx=355*
The ratio was approximately 1 P1NP to 3.5 CTx.
This means that the CTx number was only 3.5 times higher than the P1NP number.
Another way to compare the two scores and track progress was covered in a YouTube video by Dr. Doug Lucas last December.
Here's the link: https://youtu.be/NgZf1Vu8UyM?si=elj8Y6u_bWMLY9UT
This is the equation that he uses:
P1NP ÷ (CTx ÷ 1000) = X
When the answer (X) goes up, you're headed in the right direction.
Here are the numbers that I get when I do the calculation for my January and April tests:
January = 95.5
April = 287
Knowing the P1NP in my case makes a huge difference.
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Thanks for informing me of CTX as a marker for osteoclast growth.
What I understand is that one should not continue Tymlos injections in excess of two years (FDA approval limit). Fosamax is my option suggested by my Endo.
I will get a DEXA scan as well at the end of Tymlos treatment.