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

It seems to me that all of these mean baseline numbers are greater than 250 pg/ml.

Ibandronate Alendronate Risedronate Young controls
N 57 57 58 87
CTX, ng/mL, mean baseline 0.68 0.64 0.59 0.32

What am I missing? (sorry for the loss of formatting.)

Lucas suspends the idea that bone markers results from his patients and from other studies are pending. It would be good to see a comparison of the bone marker ratio to dxa. Have you seen or heard anything.

To anyone who had bone turnover markers (CTX or P1NP or both) tested: did your insurance pay for the lab if the lab was ordered by PCP or other physicians instead of the endocrinologist/rheumatologist who manages your osteoporosis? I have an employer-sponsored BCBS ppo plan, if it makes a difference. Thanks a lot!

This is the distribution of CTX values among the treatment naive post menopausal women in TRIO study, red line = 250 pg/ml:

@mayblin ,
Mine were done in the last couple of months, and so far I have not received a bill for them (but they were ordered by my bone health doc). My doctor did warn, on a cover sheet provided with the orders, that insurance may not cover all tests she ordered. We have commercial insurance through my husband’s employer. May be able to call insurance company and let them know your doctor wants you to have tests, and you are checking to see what your copay would be?

I am starting to see that having a doc who properly presents necessity seems to make all the difference. I had a rheumatologist (I was referred to by my PCP), who told me no way would I be approved for Tymlos without first trying fosamax, and that bone markers are unnecessary . He said this as he typed into his laptop a script for fosomax. Well, the bone health doc I went with substantiated the need for an anabolic in my case (very poor dexa in spine, low CTX, but also inadequate P1NP, problems with acid reflux already, etc), and I have been approved for Tymlos as first osteo med! I hope you are able to get what you need without crazy expense! This is all such a multi-faceted situation to navigate!

Thank you very much for your input @babbsjoy! very happy for you getting tymlos approved so that you get a head start to build some quality new bones.

My insurance pays for bone markers although previously the labs were ordered by my endo. I'm at a juncture now when I'd like to be tested more often. My pcp had no problem ordering the (extra) labs for me but she's not sure if insurance will pay for it since she is not the specialist treating my op. From my insurance app I could see in the past the lab billed my insurance a hefty $amount, which was more than double of the retail cash price if i were to order the tests myself online. After "network discount and deductions", the lab gets reimbursed with a fraction of the original amount they billed. In case my insurance doesn't pay btms because of the "wrong" ordering physician, I'd be stuck with the hefty bill. In that case, I'd be better off by ordering the test myself. This is my dilemma now and I'm seeking for answers from those who went through a similar situation.

How do you interpret this slide?

I am about to complete my 2 yrs of Tymlos. My basic metabolic panel #s are normal. Mt CTX is 321 and P1NP is 49. Unfortunately, I don't have baseline value from Aug 2022 as I or my Endo wasn't familiar with OP markers like CTX and P1NP. Endo, however, did thorough blood work and urine test for routine markers. We waited to start Tymlos until my Calcium, and VitD returned to normal range.

Thanks

This graph showed the distribution of CTX values among postmenopausal women who were treatment naive (never had any meds for osteoporosis) in TRIO study. Basically it shows that for most untreated postmenopausal women with op, CTx falls in "normal range"; only about 20% had baseline CTX above the upper boundary of the normal range while very few below 250.

Was your set of bone markers (ctx 321, p1np 49) done recently near the end of tymlos treatment? Did you have bone markers done during tymlos therapy? What is your plan after tymlos? Thanks!

Hi @mayblin,

I really appreciate you looking out for me. Thanks for the note 🙂

You are likely right on alendronate not being effective enough to catch the rebound, but I'm going to try it and measure CTX monthly. If / when my CTX goes above my baseline, I will switch to Reclast. This is something Serge Ferrari suggested last year during a presentation he gave and there is a hypothesis as to why it might work. I talked about it in my Prolia presentation https://youtu.be/XiRN3UvOEYg?si=XbRjR9MaqN3UihrL . BTW, I watched a presentation last week from the 2024 World Congress of Osteoporosis and Professor Bente Langdahl (denosumab expert) said on average, they give three Reclast shots in the first year to blunt the rebound for long term Prolia users.

I really want to wait to use Reclast as my very last treatment at 80 years old. Reclast lasts a really long time on the bones so taking holiday's will probably not be as big of an advantage as being on alendronate. Dr. Mike McClung has proposed this strategy.