My P1NP was 78 on 20 mcg of Tymlos. Later, it was 190 on 40 mcg of Tymlos, just recently it was 310 still on 40mcg of Tymlos. My CTX has been at 1400 since I have been on 40mcg. Tymlos increases both P1NP and CTX. My endo wants to lower CTX, so has prescribed Evista. He first wanted to put me on Fosomax, but I can't take that due to stomach issues. I wanted Estrogen, but he wouldn't give it to me, because I am 20 years past menopause. So of I take Evista, I will be doing a combination of Tymlos and Evista.