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Bone turnover markers (CTX and P1NP): do you have a baseline?
Currently i am on forteo therapy with a couple bone markers tests done. However, I didnt have ctx or p1np tested before the start of forteo as a baseline, regrettably.
It is known that the CTX value varies greatly among different individuals, with a very wide range. For post menopausal women, the range could be 34 - 1037 pg/ml; while for perimenopausal women 34-635 pg/ml. Different labs also have a slight different range values.
CTX, a bone resorption (breakdown) marker, is heavily influenced by a number of factors, such as food intake, circadian variation and exercise/life style, etc.
Bone remodeling is a dynamic and complex process. CTX itself may not fully reveal the whole picture. The bone building marker P1NP, is a lot less influenced by external factors. Taking both into consideration at the same time may shed more lights than looking at CTX or P1NP alone.
For those who had their CTX and P1NP tested before treatment with a bone drug, could you share the results if you don't mind? Thanks a lot!
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In this context patient should only be used as a noun. Patience isn't a virtue in the health care.
I lost my pen's mid care (they may have been stolen). After a month my CTX had dropped at a greater percentage than the P1NP to the advantage of my bones. I suspect a three week interruption would have been preferrable.
@gently could you clarify the timeline of your "After a month my CTX had dropped at a greater percentage than the P1NP to the advantage of my bones"? Were the readings one month after interruption or one month after restarting Forteo? CTX and P1NP both had a drop? Thanks
@gently
I am sorry your med was stolen! Despicable ! But I’m glad it ended up to your benefit! What a relief for me to know that—thank you! Your message is so well timed. I just finished my walk and with a clear mind was reflecting that this pause may be to my benefit. I had labs done yesterday, and although the bone markers are still pending, a lot of the rest is available for view. All is well except that my vitamin D has gone from being strongly in range, to below the acceptable range. Good to know and I will address it with doc when have all info in and can address all/any issues at once (very busy office so want to just address everything at once if possible). I firmly believe in taking responsibility and being assertive and getting things done (you are right—a thin line between being reasonably patient and becoming overlooked and falling between the cracks—pun intended haha!) and I also believe our Lord can and will work things out for our good! Excited to see how all this goes! Thank you, again, for helping me feel more sane about the med interruption!
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2 Reactions@mayblin
647 pg/mL to 424pg/mL CTX
102 mcg/L to 126pg/mL P1NP
The only thing this proves is that you shouldn't try to discretely give yourself an injection in the airport, even if your flight is delayed.
Intriguing though.
Any thoughts?
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1 ReactionIt is indeed intriguing both CTX and P1NP trended in favor of bone building. I wonder if this phenomenon is repeatable, or if it is related to the stage of Forteo therapy. Thank you very much for sharing @gently !
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1 Reactionhi mayblin, if it were repeatable would repeats obviate the significance of stage?
Many of the research articles use CTX and P1NP as direct indications that bones are strenghtening or at least gaining density. Is there a CTX/P1NP thread? It would be interesting to align bone markers with dxa results.
That's a great question @gently . I'm amazed with the fact that the original 2yr treatment limit for Forteo coincides with the anabolic window, which was reflected in CTX and P1NP changes in various studies. If the results of Fisher rats didn't exist, we'd have a lot more info about teriparatide's longer term efficacy, maybe a lot more about dosing regimen as well. Moreover, we might not have the current situation where long term op management is heavily dependent on antiresorptives while the other side of equation is partially missing.