Bone turnover markers (CTX and P1NP): do you have a baseline?

Thank you! I am cautiously excited to have this opportunity . Grateful, but apprehensive . I’m not a big med person, and have been blessed to not to have had to take much in the past. I know this means more meds for the rest of my life—and what comes after Tymlos is more troubling. But one step at a time! I read somewhere in these posts that someone was asked, “If you had cancer would you refuse treatment because of possible side effects? “ I knew someone who did that very thing, trying to heal holistically. I was with him as he died. So this resounded with me, as I want to continue to be active and independent. (Not that meds are necessary for everyone with osteo, but given my stats it appears to be necessary for me)

Thank you! I am cautiously excited to have this opportunity . Grateful, but apprehensive . I’m not a big med person, and have been blessed to not to have had to take much in the past. I know this means more meds for the rest of my life—and what comes after Tymlos is more troubling. But one step at a time! I read somewhere in these posts that someone was asked, “If you had cancer would you refuse treatment because of possible side effects? “ I knew someone who did that very thing, trying to heal holistically. I was with him as he died. So this resounded with me, as I want to continue to be active and independent. (Not that meds are necessary for everyone with osteo, but given my stats it appears to be necessary for me)

65yo female; postmenopausal 11years. Dexa as of 03/2024
Region /Density(gm/cc)/T-score/Z-score
APspine L1-L4/ 0.76 / -2.6 / -0.8
FemoralNeck left / 0.588/ -2.4 / -0.8
Total Hip Left / 0.754/ -1.5 / 00.3

P1NP & CTx taken 11 wks after commencing Alendronate 70mg weekly. QuestDiagnostics labs taken same time; 6:00am; fasting and off collagen and biotin for 4days. P1NP =17 mcg/L. CTx =69 pg/mL which converted to mcg/L, I believe is .069. Unfortunately I don't have an original baseline prior to treatment.

Am taking additional supplements:
-3x week: K2 (MK7) 90mcg, D3 5000iu 3x week, CoQ10 50mg, methylated B12, biotin 5000mcg, iron bisglycinate 25mg. Starting after the tests - 50mg VitE Tocotrienols+75mgGG
-4x week: calcium hydroxyapatite 500mg & magnesium malate/glycinate 350mg
-daily - multi w/VitC,..; marine collagen 2.5g

Considering getting labs retested around 8mos. Any thoughts comments are appreciated.

It is observed that in post menopausal women, almost no one's ctx is below 250 at baseline, with just a few exceptions. Once a bisphosphonate is started, a responder's ctx generally goes down a lot by week 12. In this case, fasamax. On average, ctx goes down by 50% by week 1 and 80% by week 12 of fosamax treatment. Ctx stays down (p1np too) as long as you stay on the med. Assuming your baseline ctx is 250 (rare, chances are you had a higher baseline ctx), you had a 72.4% reduction in ctx in 7 weeks of fosamax treatment! Please share your results if you are going to test again, if you could.

Curiously, what's the reason of supplementing methylated B12? Did you get tested for the need?
Thanks a lot?

It is observed that in post menopausal women, almost no one's ctx is below 250 at baseline, with just a few exceptions. Once a bisphosphonate is started, a responder's ctx generally goes down a lot by week 12. In this case, fasamax. On average, ctx goes down by 50% by week 1 and 80% by week 12 of fosamax treatment. Ctx stays down (p1np too) as long as you stay on the med. Assuming your baseline ctx is 250 (rare, chances are you had a higher baseline ctx), you had a 72.4% reduction in ctx in 7 weeks of fosamax treatment! Please share your results if you are going to test again, if you could.

Curiously, what's the reason of supplementing methylated B12? Did you get tested for the need?
Thanks a lot?

I apologize if my previous explanations about CTx to P1NP (CTx:P1NP) were unclear. Let me attempt to clarify here. But before I do, I'd like to share a simpler way to track treatment progress that I learned from a YouTube video from Dr. Doug Lucas posted last December.
You can watch it here: https://youtu.be/NgZf1Vu8UyM?si=elj8Y6u_bWMLY9UT

Dr. Lucas uses this equation:
P1NP ÷ (CTx ÷ 1000) = X

When the result (X) increases, it indicates you're moving in the right direction. Here are my results from January and April using this calculation:

- Before Evenity treatment (January): X = 95.5
- 2 weeks after the 3rd Evenity treatment (April): X = 287

The number went up dramatically with Evenity treatment, so I know that it's working.

Now, let me provide a clearer explanation of the 10:1 ratio:

A good ratio in this context means that for every unit increase in CTx (a marker of bone breakdown), we ideally want to see a proportional increase in P1NP (a marker of bone formation).

For instance, if the ratio is 10:1 (10 to 1), it suggests that for every 10 units of CTx, there is 1 unit of P1NP. This indicates a balance where some bone formation is occurring relative to bone breakdown.

If our goal is to increase P1NP, we should ideally see the ratio adjust accordingly. A higher ratio, like 10:2 or 10:3, would mean that for every 10 units of CTx, there are 2 or 3 units of P1NP, respectively. This higher ratio indicates more bone formation relative to bone breakdown, which is beneficial for bone health.

Therefore, a good ratio when aiming for an increase in P1NP shows a proportional or higher increase in P1NP compared to CTx, suggesting improved bone formation relative to breakdown."

I hope that's helpful. It can be a real brain twister.
If your goal is just to track treatment progress, I recommend using Dr. Doug's equation. It's far more straight-forward.

What is the source of your claim that almost no post-menopausal woman's baseline CTX is below 250?