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!