@babs10 the etiology of osteoporosis is heterogenous, even among post menopausal women. Some op patients could have more than one cause. For those who develop op mainly due to estrogen deficiency, most of time we will see a higher CTX reading which could be within normal range. Only ~20% op patients have a CTX higher than 800, while very few have a CTX below 250 (comparing heathy young women: 50% below 250 and 50% above 250). Bone markers definitely are not a tool for diagnostic purposes. Both your CTX and P1NP are reasonable presently, but we don’t know your past readings as first 5-10 year after menopause women tend to lose bone fastest. There might be reason(s) other than estrogen deficiency causing your hip bones bmd loss over the years. I’ve read that natural bone structure, prolonged sitting, abnormal mechanical stresses as well as blockage of small blood vessels around hip, etc. could all be the causes of bone loss around hips.

The discordance between your hip and spine Dexa readings belong to minor “low hip discordance”category (osteoporosis hip vs osteopenia spine), proper treatment should be oriented to the hip. There was a small study showing low hip discordance among the BMD discordance types is a risk factor for hip fracture. If wait and see approach is elected as Miller recommended, preventive measures for hip fracture become necessary.