@lisanne, the bone markers changes during evenity is dynamic. The peak increase of P1NP is at 2 weeks after initial dose according to clinical trial data, with an average increase of 145%. After that it trends down. Your btm lab was at 5 month of evenity, most likely the increase of P1NP was missed due to timing of lab.

Your CTX results is a bit more challenging to read, since you had evenity + HRT simultaneously. As you know, a typical transdermal dosing of 0.05mg estradiol could be used as an antiresorptive, although estrogen has many other roles in benefiting bone health. Evenity in itself is a dual agent serving as an anabolic as well as an antiresorptive. It’s maximal effect on CTX also started at 2 weeks after initial dose, although first few months of evenity therapy is anabolic. So your CTX at 5mo evenity would be under influence of both evenity and HRT. When CTX is reduced, P1NP usually follows due to coupling effect, therefore you see both markers suppressed.

Good studies on HRT’s effects on CTX and P1NP are hard to find. Id expect there is a dose-effect response relationship, especially at lower doses. Antiresorptive effect may reach a plateau at higher dose of estrogen. Did you discuss reducing HRT from 0.1 to 0.05mg with your physicians? After evenity treatment, the main goal is to maintain what’s gained, so I’d think adequate antiresorptive dosing is important.

I’m sorry to hear that you had reoccurrence of foot fracture as they tend to take time to heal. During healing, supportive footwear might be very important.

Btw, you had nice gain on evenity, noting not everyone will have bmd gains as advertised. You only took fosamax for about a year. It may not affect evenity that much, although it’s hard to say for sure.