Blood Marker Testing

Babs, I'm certain that the disability is in my expression. I hope you don't give up until you're thinking--Why didn't she just say that to begin with.

If your bone density were that of the (non existent) 30 year old that our densities are compared to 324pg/mL with in the range of 104- 1008pg/mL is low normal 60mcg/L P1NP is mid normal in range of 16 to 96 mcg/L So your rebuilding is keeping up with the breaking down. You have effective remodeling.

The markers say that you are maintaining the bone density you now have. If your bone density is low you are maintaining that low bone density.

If your CTX were 1008pg/mL and your P1NP 16mcg/L, you'd be losing bone density according to the bone markers.
The way medical practitioners use the markers is to determine patient compliance with taking their medications and to determine if a medication is working. The markers aren't used to diagnose osteoporosis. They have been used to determine which medication should be prescribed. After Forteo was approved it was thought that the bisphosphonates were best if CTX was high. Now thinking is shifting toward anabolics first.
My private opinion is that you can't regain very much bone loss without pharmaceuticals. There are wonderful ways to try and some people seem to be successful. It is a slower process than meds and the risk of a meanwhile fracture is why many of us take medications.
"Vast understanding" gave me a good laugh. Whatever my understanding, I have even less experience. It's best to question anything I write.

@gently, "The markers say that you are maintaining the bone density you now have. If your bone density is low you are maintaining that low bone density" helped so much.

I have discordance btw my hip at -3.5 and my osteopenic spine and the hip is a challenge to target. My impression is it's hard even with meds (recently watched a presentation where the MDs said teriparatide can even make it worse) so I'm in a quandry. The whole purpose of meds is not to fracture so I'm sure I'll end up taking something or other. Tymlos is like Forteo and I don't think I can take Evenity. Sometimes, I want to curl up into a ball forever.

Thank you again for your help. < 3

@gently, "The markers say that you are maintaining the bone density you now have. If your bone density is low you are maintaining that low bone density" helped so much.

I have discordance btw my hip at -3.5 and my osteopenic spine and the hip is a challenge to target. My impression is it's hard even with meds (recently watched a presentation where the MDs said teriparatide can even make it worse) so I'm in a quandry. The whole purpose of meds is not to fracture so I'm sure I'll end up taking something or other. Tymlos is like Forteo and I don't think I can take Evenity. Sometimes, I want to curl up into a ball forever.

Thank you again for your help. < 3

Babs10, I know that feeling. It's a warning that you are getting ready to roll.

I'm familiar with the idea that Tymlos is more effective at raising dxa bone density numbers for both hip and femur than Forteo. Greater porosity with Forteo may reflect greater resilience. Lower density in cortical bone can yield on impact rather than break.
I'm curious about the concept that teripartide can make osteoporosis worse. I think the MDs in the video (I haven't seen) meant geater porosity so less density with Forteo compared to Tymlos. Density and strength are not the same measurement.
Patients can lose bone density while on Forteo because of unresolved cause ( like hyperparathyroidism), when medical providers fail to screen for secondary causes of osteoporosis.

@rjd, When teriparatide was prescribed, the pharmacy called me to make sure I understood the cost. I didn't!!! so I called Medicare and was referred to my supplemental. My supplemental referred me to my Part D prescription plan and I was told $1927/month was the copay. I am not eligible for any financial assistance. I saw a second MD who prescribed Tymlos which is even more expensive and not included in my Part D formulary. I saw a third MD and he prescribed Evenity. I haven't made any decisions about medication and was surprised that he contacted the infusion center without further conversation - I was waiting for the results of the CTX and P1NP. I called the infusion center on Friday and they told me they couldn't tell me if Evenity was covered unless I had an appointment so I made an appointment and hope to hear back from them this week. I don't think I can take Evenity due to a blood clot DX in my 20s, but wanted to play this out pending further conversation with the doctor.

I forgot that Evenity is different (thanks @susanfalcon52) b/c it is given at an infusion center so I'm sure I'm wrong about that one and have to wonder why the my Part D prescription plan and the infusion center didn't tell me that. Based on what @windyshores wrote, I will call Medicare and double check on Tymlos. Nothing about this diagnosis is easy.

Babs10, I know that feeling. It's a warning that you are getting ready to roll.

I'm familiar with the idea that Tymlos is more effective at raising dxa bone density numbers for both hip and femur than Forteo. Greater porosity with Forteo may reflect greater resilience. Lower density in cortical bone can yield on impact rather than break.
I'm curious about the concept that teripartide can make osteoporosis worse. I think the MDs in the video (I haven't seen) meant geater porosity so less density with Forteo compared to Tymlos. Density and strength are not the same measurement.
Patients can lose bone density while on Forteo because of unresolved cause ( like hyperparathyroidism), when medical providers fail to screen for secondary causes of osteoporosis.

It is my understanding that many folks receive an Evenity injection in their doctor's office, not at an infusion center. I had one of my Prolia shots at an infusion center and the other one in my doctor's office.

I think the difference between processing and paying for Forteo/Tymlos and Evenity likely hinges on whether a medication is self-administered at home or administered in a clinical setting.

If at home, then you should look to your Medicare Part D plan.....what is the deductible and copay, is the drug on the formulary (apparently Tymlos is not on your Plan's formulary) and if it is not on the formulary, whether you should ask for an exception. Your doctor will need to be involved in trying to get an exception.

If the medication is given in a clinical setting, then the Medicare B process is used. This means Medicare usually pays 80% and you pay 20%. Then you look to your Medicare Supplement Plan or your Medicare Advantage plan for applicable deductibles and copays.

It seems most supplement plans pick up your entire share of the cost of Evenity because it is a Medicare B medication. The supplement plans do not cover Medicare Part D drugs for which you have a separate Plan.

I am hoping that if my understanding about Medicare B drugs and Medicare D drugs is incorrect, someone will set me straight.

Welcome to the Wonderful World of Medicare.

@rjd, When teriparatide was prescribed, the pharmacy called me to make sure I understood the cost. I didn't!!! so I called Medicare and was referred to my supplemental. My supplemental referred me to my Part D prescription plan and I was told $1927/month was the copay. I am not eligible for any financial assistance. I saw a second MD who prescribed Tymlos which is even more expensive and not included in my Part D formulary. I saw a third MD and he prescribed Evenity. I haven't made any decisions about medication and was surprised that he contacted the infusion center without further conversation - I was waiting for the results of the CTX and P1NP. I called the infusion center on Friday and they told me they couldn't tell me if Evenity was covered unless I had an appointment so I made an appointment and hope to hear back from them this week. I don't think I can take Evenity due to a blood clot DX in my 20s, but wanted to play this out pending further conversation with the doctor.

I forgot that Evenity is different (thanks @susanfalcon52) b/c it is given at an infusion center so I'm sure I'm wrong about that one and have to wonder why the my Part D prescription plan and the infusion center didn't tell me that. Based on what @windyshores wrote, I will call Medicare and double check on Tymlos. Nothing about this diagnosis is easy.

Ugh, yes. I'll ask about treatment in the MD office vs. infusion center. Did it make any difference in your coverage? Your explanation sounds correct, but yes someone will let us know! 🙂