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

I already reported my P1NP and just got my CTX in. I started tymlos on 5/24/24 titrating up and started full dose on 6/15.

5/9/24 - Baseline P1NP - 75
8/28/24 - P1NP - 162

5/9/24 - Baseline CTX - 451
8/28/24 - CTX - 473

I don’t know if the numbers are affected by my previous fracture. Is CTX supposed to go up?

@bluebonnet242 i think these are great numbers at 2-3mo Tymlos' therapy! Tymlos doesn't increase ctx that much so your number is within expectation when compared with results in clinical trials. The more important p1np increased 116% which is wonderful!

According to literatures, after a fracture the significant increase in bone markers is during first few weeks. Ctx could peak at 4 weeks while p1np at 12 weeks after a fracture. Later on both markers could stay elevated throughout the healing process. Since it's been more than 6mo since your fracture, your p1np jump most likely is due to Tymlos' effect. Thank you very much for sharing your therapy progress. Best wishes to you!

Before I started Evenity my numbers were CTX 933, P1NP 77.
After 1 year and before starting Prolia P1NP 25 . My MD put in a wrong lab of NTx which was 8.7 . She then ordered the corrected lab but it was a week after starting Prolia and it was 39 . From my understanding Prolia can drop these numbers even after a week .
I will do follow up labs in 3-4 months .

Hi ladies…I’m so confused at what numbers are good or bad for P1NP and CTX. I finished Tymlos in June after 2 years, started bioidentical hormones shorty after and am supposed to begin Evenity next month. Had to take a few months off meds because of traveling. Had my bloods drawn before beginning Evenity and my P1NP is 74 and CTX 420. I’m 72 and active but would love not to take another med. my new rheumatologist is adamant about Evenity and not happy I’ve taken a break (no pun intended) from meds till next month. Can someone comment on my numbers please? Thanks

@kristie2 the set of btms that you did before evenity could be served as your new baseline for prolia therapy for future comparison I think. Too bad ctx was missed but I suspect it being much lower than your original baseline prior to any osteodrug therapy, since currently you have HRT at work as a backgroud also. Your ctx reading of 39 one week into prolia most likely is within expectation. This is an excerpt from btm substudy of Freedom trial for denosumab (prolia):

"The changes in bone-resorption markers with denosumab do not remain steady over the dosing interval; there is suppression within 12 hours of administration of the drug, with median decreases in bone-resorption markers of 80% or more. There is subsequently a resolution of effect before the next injection, and this cycle of marked reduction followed by a release in bone turnover markers (BTMs) occurs after each injection"

As the authors stated, the btms decreased 80% or more within 12 hours after prolia injection - your 39 ctx reading is expected, except you don't have a pre treatment value to compare with.

Wish the plan you and your endo picked works out great for you. Thank you very much for sharing your journey along the way!

Thank u for your input . I love to hear what you have to say .
The only maker was the NTX that was done by mistake which was 8.7 . I guess I will just have to wait and see what my CTX is at my next draw . My last CTX before starting Prolia was in May and it was 138 while still on Evenity .

@dooshie this is a great question with no definitive answer for it in my opinion. Many members on this forum shared their bone markers at baseline as well as during various therapies. Since bone markers vary greatly among individuals at baseline and they repond in various degrees during therapy at individual level, i think monitoring trends after the start of a therapy is very useful.

Your set of p1np 74 and ctx 420 is from a recent lab, or ~2 months after finishing tymlos, right? Do you have btm lab at the end of tymlos therapy? If you do, you could compare them. Use my case as an example, I started hrt right after finishing forteo. The lab was done right before the start of hrt and one month after. It showed ctx had 28% reduction to 572 and p1np stayed at 150, which is nice for me to know the resorption went down quite a bit while formation marker didn't change. The btms will be monitored periodically to see if hrt dose needs to be adjusted. Hope you have a set of btms to compare with to see how they trend. But otherwise from your absolute numbers they look OK to me - p1np in the upper half of the range and ctx closer to 300s. One thing for sure, hrt will prevent bone loss to certain degree - it's a matter of dose and whether other secondary cause(s) of op is involved and under control. Hope other members chime in with their opinions. Take it easy and enjoy your trip!

Question:

60 year old Male. Pretty Athletic. Delayed back surgery due to Osteoperosis.
My CBeta-CrossLaps (B-CTx), S is: 1105
My Procollagen I Intact N-Terminal, S is: 106
Makes my ratio around 10:1
Do these numbers seem oddly high, or is this relatively common?
Responses from two doctors" one shrugged and said it didn't mean much, the other seemed shocked and suggested drugs.

Also, should I be fasting and taking test in the mornings?

@balake
yes, fasting 12 hours, no biotin or collagen supplements two days before, no vigorous exercise before the test.
and early morning testing. If your labs are accurate, you are probably losing bone.
Some doctors don't think that bone markers are reliable enough to use meaningfully.
But aren't you prescribed a medication to ready your bones for surgery.
My choice would be to take one of the anabolic medications Tymlos or Forteo.

Take the tests in the morning after fasting. 1100 is on the high side, but I am not sure about male numbers. If you direct message @mayblin she seems pretty knowledgeable. I would get an opinion from an integrative medicine specialist. Dr Bazzan in Philadelphia is excellent. Good luck.