@windyshores Tymlos is not expected to raise serum NTX but rather the opposite, but there are many factors that can affect the results: prior treatment, circadian rhythm, inflammation, other disease processes etc. Urine NTX is considered more reliable, but neither is ideal. CTX seems to be the standard to date. Altogether, many doctors consider these tests to be inconclusive but patients often request them for reassurance. My NTX below reference post Evenity was anticipated and hoped for. I'll let you know what I find out, but tbh my current endo is not a reliable source of information.