Blood Marker Testing

@babs10
the normal range is so broad that I haven't seen any numbers in the literature where an osteoporosis patient was out of range. The scales are 20 years old and were developed by the assay labs and adopted by medical providers.

From what I've observed (from my own dxas and from reading) women lose the most estrogen and bone in the first 5 years of menopause. Bone markers would be of value then. There should be a separate range for women from 50 to 55. Speculating; when you first lose bone your bone markers rise. After bone loss your markers will settle back down because you are not building bone. Where bone is lost blood supply and nerve supply are also lost. Without intervention your body hasn't a way to rebuild the bone. Your serum levels of markers reflect reduced rebuilding.
Before Forteo, the only way to medically address osteoporosis was by reducing osteoclasts. Bisphosphonates were the medication we used. Osteoclasts were maligned, undeserveably. Lower really isn't better. More commonly. now, bone specialists are saying that it is best to raise osteoblasts than to supress osteoclasts, especially in osteoporotic women. Reduction in bone formation is the primary reason for age related bone loss. Turnover is said to increase by 50 to 100% within the first years of menopause because of the loss of estrogen. It's higher in a desperate attempt to save those bones.
So babs, your bone markers look perfect.
The bone markers will be of benefit to measure the effect of medications. With Forteo or Tymlos markers are best taken at 2 month not 3 as is common.
Best use for bone markers has not been sufficiently explored.

@mayblin, Interesting. Thanks so much for laying all of that out. Dr. Miller shrugged and said that it could be microstructure of my hip and this may be the way I was born. I was surprised to get a call from the infusion center without having another discussion with him. I don't think I am a candidate for Evenity (not covered by medicare by the way, but neither is Tymlos) because I was diagnosed with a blood clot in my 20s and I have high blood pressure (controlled by low dose meds). It's not from prolonged sitting, that I know. What would be an example of an abnormal mechanical stress?

I'm off to read T-score discordance between hip and lumbar spine: risk factors and clinical implications and hope I can decipher it. I have trouble understanding these studies! Opening commentary: "T-score discordance is common in osteoporosis diagnosis and leads to problems for clinicians formulating treatment plans." Great.

Just read a bit. How do you know if this is a minor discordance vs. major? TIA

Thanks again.

@mayblin, Interesting. Thanks so much for laying all of that out. Dr. Miller shrugged and said that it could be microstructure of my hip and this may be the way I was born. I was surprised to get a call from the infusion center without having another discussion with him. I don't think I am a candidate for Evenity (not covered by medicare by the way, but neither is Tymlos) because I was diagnosed with a blood clot in my 20s and I have high blood pressure (controlled by low dose meds). It's not from prolonged sitting, that I know. What would be an example of an abnormal mechanical stress?

I'm off to read T-score discordance between hip and lumbar spine: risk factors and clinical implications and hope I can decipher it. I have trouble understanding these studies! Opening commentary: "T-score discordance is common in osteoporosis diagnosis and leads to problems for clinicians formulating treatment plans." Great.

Just read a bit. How do you know if this is a minor discordance vs. major? TIA

Thanks again.

Would you please share the source of your information about Medicare not covering Evenity or Tymlos? This is the first time I have heard this. Thanx.

babs10,
Evenity is covered by traditional Medicare if you have the injections in an infusion center.
I just had my 12th Evenity injections and every penny of the $5,000+ cost was paid by Medicare.
When I first started the drug, both the endocrinologist and the rheumatologist called the infusion center that very day to schedule it. The infusion center called me before I got home from the doctors office.
I am shocked at the price tag on Evenity and would love to see the breakdown of where the money goes.
As far as results, I have a dexa tomorrow and will report back.

@babs10
the normal range is so broad that I haven't seen any numbers in the literature where an osteoporosis patient was out of range. The scales are 20 years old and were developed by the assay labs and adopted by medical providers.

From what I've observed (from my own dxas and from reading) women lose the most estrogen and bone in the first 5 years of menopause. Bone markers would be of value then. There should be a separate range for women from 50 to 55. Speculating; when you first lose bone your bone markers rise. After bone loss your markers will settle back down because you are not building bone. Where bone is lost blood supply and nerve supply are also lost. Without intervention your body hasn't a way to rebuild the bone. Your serum levels of markers reflect reduced rebuilding.
Before Forteo, the only way to medically address osteoporosis was by reducing osteoclasts. Bisphosphonates were the medication we used. Osteoclasts were maligned, undeserveably. Lower really isn't better. More commonly. now, bone specialists are saying that it is best to raise osteoblasts than to supress osteoclasts, especially in osteoporotic women. Reduction in bone formation is the primary reason for age related bone loss. Turnover is said to increase by 50 to 100% within the first years of menopause because of the loss of estrogen. It's higher in a desperate attempt to save those bones.
So babs, your bone markers look perfect.
The bone markers will be of benefit to measure the effect of medications. With Forteo or Tymlos markers are best taken at 2 month not 3 as is common.
Best use for bone markers has not been sufficiently explored.

hi babs,
You can see the extent of remodeling because bone markers measure specific fragments released in the process. CTX is a fragment of type 1 collagen released in the bloodstream during resorption when the osteoclasts release an acid on bone. P1NP measures fragments cleaved from type 1 collagen when the osteoblasts fits the collagen into the pit letf by the osteoclasts.

I should have written your serum levels of markers reflect less rebuilding than higher number of balanced CTX/P1NP would.
The way we commonly look at the numbers, your's look perfect. The osteoclast/osteoblast couplet looks balanced. And the numbers are at the lower end of normal rather than the higher number.
In perfect balance you aren't removing more bone than you are replacing. And your BMD ( though not your bones) would be stable or (wouldn't change). We need higher balanced numbers to increase BMD.
(Unless,
we are taking bisphosphonates or Prolia. The antiresporptives completely alter the balance. Eliminating the remodeling process, increasing BMD by collecting older bone preventing renewal.) CTX/P1NP numbers are low when there isn't as much bone turnover.
Research hasn't revealed a perfect balance. The numbers aren't used for diagnosing osteoporosis. The are used separately to determine response to medications.
I'm leave this link because I like the video
https://www.youtube.com/watch?v=Cd0YT-OV97c