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

Hi @balake I agree with @gently, if this is your baseline bone marker readings, the CTX looks high. For males around 60yo, the upper boundary of reference range for CTX seems to be in the 700s (although an Europian assay renders 1000-1100 CTX reading for upper reference range) - it could vary somewhat with different assays and maybe among different ethnicity. Your P1Np reading is good, most likely due to the coupling effect. Unless you had a recent fracture and/or immobilization which could increase CTX and P1NP, it's worth looking into the cause(s).

Have you taken any osteodrug(s)?

I had no knowledge of bone resorption biomarkers until I found this group. Through you all, I learned to seek out an endocrinologist who has been wonderful. After months of tests, including my recent 24 hour urine calcium, and her consulting with a blood oncologist for other detailed blood findings, we finally agreed on starting Forteo. Through this support group I found Keith McCormick and the biomarker info. Last week I asked my endocrinologist about that before starting Forteo, and she said she would be happy to prescribe the lab (fasting) but that currently this info will not affect or guide my treatment, that (Kaiser) current medical science can't utilize the data effectively. So, I'll have the data and look for further guidance from this incredible Mayo Clinic Support Group.

@kar50,
excellent choice: Forteo.
The provider I see has the same idea about bone markers. He always orders both CTX and P1NP for all of his patients, but says he doesn't use them for treatment patterns. I'm a little fascinated with the markers and will enjoy seeing yours particularly with Forteo.
Some people experience adverse events. Tell us everything.

@mayblin
Looking back over this discussion , to refresh my memory as I will go in AM for new labs, including bone markers. I have been on Tymlos about five months now. Our insurance with employer changed in the new year, and so far they are declining my need for an annabolic and will only cover a bisphosonate. My doc left for another part of the country, and the doc in practice I will now see wants testing to determine if “Tymlos is even working” (which is reasonable!). BUT my pen expires tomorrow, and I can’t get in to see the doc that is new to me, until mid February. So unless something wonderful happens in all the communications with insurance, or my scores wow the doc and they agree to give me a sample pen to keep me going while it’s worked out (and prior to appointment), I will be off med for at least a month. (I am willing to try to self pay generic Forteo, so hopefully doc will prescribe if labs support). This is so frustrating! Praying labs are great!

babbsjoy, you'll probably be in luck. The bone markers will have changed and the bone density will not have changed because it takes a while for the bone markers to affect bone density. Don't let the new doc depend upon density improvement.
I suspect the pen will not expire at midnight, but call the Forteo pharmacist to be certain. The last point is that it will not likely be harmful to have a month hiatus. You already have some fracture protection from the medication. Praying with you.

Hi @babbsjoy did you have a btm baseline, and btm labs during month 1-5 tymlos therapy? If so, any indication of anabolic effect from these data can serve as evidence that tymlos is working and should be sufficient to show your new endo imo. For some people, the biggest change in p1np is in early months 1-3 while on tymlos. It's also wise to get one done as you planned since btms most likely will change (in opposite direction) after you stop involuntarily.

I have read studies where btms ebbed and flowed with intermittent dosing of forteo (3mo on 3mo off); the resulting bmd changes at the end of study was just a bit shy of the regular daily dosing. Tymlos acts similar to Forteo, so hopefully btms and bmd outcome would be similar with interruption of the dosing, as in your case.

Hope other members who had similar dosing interruptions will chime in with experiences and outcomes. For the timebeing, take it easy - things will work out one way or the other. Keep us posted.

@gently
Thank you so much for the speedy reply. I understand the thinking behind the process with all this, as frustrating as it is. Have just been really concerned about that month-long period. Believing it will all work out, and really appreciate your kindness!

@mayblin
Thank you for the speedy response! These will be my first labs since beginning treatment—extensive labs done prior to beginning treatment (including all the bone markers, urine calcium, etc discussed in this forum). So I imagine that is my new doc’s reasoning for requiring them now.

This is just my first experience with such a high level of frustration with this kind of process (and I tried to get it addressed a month before it became such a fire drill, but with the holidays didn’t get anywhere). Being off the med for a month, and concern over the possibility of not being able to continue an annabolic, are the big points for me. I understand and appreciate the doc wanting the labs and I know insurance companies are what they are and that there is a process. Patience is a virtue I guess is going to be a necessity here! I really appreciate the reassurance from you and @gently —i feel far less isolated in the process!

I was in a similar situation last year when Cigna cut off my prior authorization for Tymlos after 4 months. I was off all medication for nearly three months until I could start teriparatide. My doctor was unconcerned and didn’t think this was a problem.

@oopsiedaisy

Thank you—that has been my greatest concern! You are kind to share, thank you! (The doc I will be seeing has a stellar reputation and I have every confidence things will work out…just have to be patient and follow the process! )