Hi @zooie you had a huge response to tymlos, there is no doubt. Interestingly the ctx jumped greatly also although p1np percentage increase is larger than that of ctx, which is good because this means the bone formation is relatively higher than the resorption compared to baseline. It is observed that CTX responded to tymlos somewhat less when compared to Forteo in clinical studies. Please share what your endo thinks about your numbers.

During my treatment with Forteo, I had a humongous increase in p1np also at 13mo (400), but ctx wasn't done at the time. At 17mo, my CTX was still a high of 910. I suspect both my p1np and ctx were a lot higher during early months of treatment had i have them tested. When treatment was finished, I had a slight lower than average lumber spine bmd gain, but decent and better than average bmd gains in hips and femur neck - a surprise with Forteo. To be honest, I was worried with my high bone marker numbers too during treatment. It turned out all is good.

I think it might be interesting to monitor bone markers periodically to see how they trend. Your endo might do further lab testing(s) if they look out of place to rule out a few things. Getting a yearly dexa scan to confirm bone building to just make sure and have a peace of mind.

Wish you the best!

zooie, your P1NP indicates that you are having a very good response to Tymlos. CTX is often not ordered with anabolics because the significance is unknown. We can speculate that the bones are remodeling evenly but more actively. CTX is more variable than P1NP. CTX numbers are affected by time of day, biotin intake, food intake before a draw, and intense exercise.
Rest assured; these are the changes that we hope for when taking Tymlos.