I have received the results of my fourth BTM blood test done in Dec 2024 after 50 weeks of Alendronate following cessation of Prolia; and my DEXA done in early Jan 2025, 13 months after my previous DEXA in Dec 2023. It's not all good news.

To recap - I did 3 half-yearly Prolia injections in Jul 2022, Jan 2023 and July 2023 and started on Alendronate at end-Dec 2023. My first BTM was in early Mar 2024, my second BTM was in end-May and my third was in Sep after 10, 22 and 36 weeks of Alendronate, respectively. I do not have any baseline BTM numbers. As per my opening post, I am sharing my BTM results in case it proves useful to anyone else monitoring their own exit from Prolia

[CTX]
CTX < 50 pg/mL (Sep: 54; May: < 50; Mar: 51)[range 171-970]
iPTH 4.9 pmol/L (Sep: 4.4; May: 3.2; Mar: 3.5)[range 1.6-6.9]
Calcium (corrected) 8.7 mg/dL (Sep: 9.1; May: 8.7; Mar: 8.3)[range 8.8-10.2]
Albumin 4.3 g/dL (Sep: 3.9; May: 4.1; Mar: 4.1)[range 3.5-5.0]

My CTX remains low and back to the mysterious, numberless '< 50' ! Calcium can afford to go up from its bottom of the range level.

[DEXA]
My TScores from my DEXA scan in Jan 2025 (Dec 2023 numbers in brackets):

Lumbar Spine -0.8 (Dec23:-1.1)
Femoral Neck -2.4 (Dec23:-2.6)
Total Hip -2.5 (Dec23:-2.6)

All DEXA scores have shown slight improvements over the past 13 months with lumbar spine falling below -1.

Now for the bad news.

[SPINAL SCAN]
I took the opportunity to also do a spinal xray scan and the results came back with a "Mild T12 compression fracture"! Was quite shocked and disappointed.

Some questions immediately pop into mind:

1) Having never done a spinal scan before, I don't know if this is an old or new fracture. But, as fractures should heal over a few months, perhaps it is not an old fracture?

2) If it is a recent fracture, could it be caused by the dreaded Prolia Rebound? But my CTX has remained very low throughout the post-Prolia period. And my lumbar BMD numbers are ok. What do others think?

3) I have read that fractures cause CTX to rise, sometimes dramatically. But my CTX has remained low throughout the past 13 months. Is this odd?

4) Should i cut short my post-Prolia relay period to allow CTX to rise to assist in healing?

5) Other than being careful and not aggravating the fracture, what else can I do to assist the healing? Are exercises and/or stretching recommended?

My aim is to cease all anti-resorptives as soon as possible. My original plan was to cease my weekly Alendronate at end-Dec 2024; move to fortnightly Alendronate for 6 months, followed by monthly Alendronate for another 6 months before stopping Alendronate altogether at end-Dec 2025. But, given my continued low CTX, I was planning on being more aggressive and do instead, 3 months biweekly, 3 months triweekly and 3 months monthly and cease by end-Sep 2025. Now, with the fracture, it might be better to shorten it even more.

I will continue to rely on timely BTM tests to alert me to any possible rebound effect

Any insight or comments on the above numbers, questions and/or plan of action is very welcome