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← Return to P1NP number on Tymlos
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I had posted on Dec 24th with my blood test results. I've been on the full dose of Tymlos since 9/29/24.
My 3/27 CTX results are super high. Also my calcium and ALP. The test dates are: 8/23/24 12/19/24 3/27/25
p1np 62 500 700
ctx 213 1560 2870
So my CTX is increasing at a much greater rate than the p1np.
(Aware that the CTX is impacted by many factors, I've been careful to stop supplements 48' prior. I inject at night and get tested the following morning. )
Also my calcium went from 9.7 to 10.5 to 11.2 and my ALP went from 115 to 129 to 163 (related to the high bone turnover?).
I have an appointment with the PA of the endocrinology office next week, but they don't really look at the bone markers.
To avoid being taking off Tymlos, I've immediately cut back on my calcium intake and can try retesting for the calcium. I could also suggest reducing the dosage. I do like the p1np results.
Thank you all in advance for your wise input.
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@zooie thanks for sharing. I agree with @gently that a serum calcium level of 11.2 mg/dL needs to be followed by your prescribing physician.
Before you get a lab for ionized calcium (the active form) done, you could get an estimation using this formula, according to medscape:
corrected calcium mg/dL = measured total serum calcium (mg/dL) + 0.8x(4 - Patient's albumin g/dL)
According to Tymlos' prescribing information, hypercalcemia is defined as albumin-corrected serum calcium equals or greater than 10.7mg/dL at 4 hours following injection at any visit.
Lilly, the manufacture of Forteo, cited that hypercalcemia was managed via reducing calcium supplements and/or Forteo doses at the discretion of the investigators in clinical studies. You might want to get your daily total intake of calcium (supplements + natural food sources) ready so that your doctor may suggest a modification plan.
Your bone markers' response to Tymlos were exceptionally strong! Literatures had been showing that btm changes with Tymlos were milder than Forteo in general. Yours demonstrated individual variation could be huge. P1Np trends nicely up! I've to admit CTX of 2870 is very high, most likely due to the coupling effect in bone remodeling (high turnover). If you monitor btms periodically, they will likely trend down eventually. But this high level is worth keeping an eye on.
For a comparison, my highest P1NP was in mid 400s at 13mo of Forteo, CTX wasn't tested at the time (I don't have a baseline nor my btms were tested during first year). Later it trended down to 200 with CTX of 910 at 17mo. Admittedly I was anxious with the high CTX level too. In the end, I had a good bmd improvements at all sites - lumbar, hip and femur necks 🙂
You will get an annual dexa scan to confirm if drug is working, right?
To me, your baseline CTX and P1NP were both at nice levels. Do you mind sharing what might have caused your bone loss?