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Mixed results 1 year after Forteo: What are your thoughts?
Osteoporosis & Bone Health | Last Active: Aug 15 2:11pm | Replies (86)Comment receiving replies
The Reclast infusion was August 2023. I started the Timos March 17, 2024. I did one month and stopped. I started the medicine again May 1, 2024. I took The P1 NP and the CTX at the beginning of June. And I just took the latest PNP last week, but it was strange that the CTX was not ordered. Do you think that it’s weird that the CTX was not ordered in companion to the P1 NP? or do you think the CTX was a marker for the reclast I took last year? (And maybe the thought is because I’m not having any more RECLAST before I finish The TYMLOS) maybe it’s not necessary? I did ask my regular primary care manager to order the CTX because I thought it was a companion to the P1 NP my surgeon last week said he thought my spinal vertebrae looked denser than six months ago, so that’s probably the best thing I could want to hear anyway. Your thoughts?
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Thank you very much @loriesco for clarifying.
According to ACTIVE study, "early P1NP changes correlate with percentage change in lumbar spine BMD 18 months after abaloparatide (Tymlos) treatment". So your P1NP increase from baseline* (after 1 shot of reclast and some partial dosing of tymlos) of 49 to 90 at roughly 2 months of tymlos (5/1-7/1) is wonderful, considering you actually had reclast 7 months prior to Tymlos. Theoretically a strong antiresorptive like Reclast would have a strong and long lasting effect which suppresses osteoclasts (CTX reflects their activities) and consequently osteoblasts (P1NP reflects their activities). The fact that your P1NP responded strongly within 3 months Tymlos suggests Reclast may not 'blunt' too much of Tymlos' anabolic effect in your case. Your next Dexa will help confirming this.
Bone markers change dynamically after the start of an anabolic. With a prior treatment of reclast, your CTX changes likely won't follow the typical average changes shown in a trial data. It definitely is interesting to observe both p1np and ctx together especially with your sequence of therapy. However, since ctx is missed at 2mo, you might want to test both markers next time if neither lab ordering nor insurance payment presents a problem. Otherwise your p1np @2mo and the coming dexa would give you enough information.
Best of luck and please keep us posted!