Bone Marker Results -??

I believe the key is to start closely monitoring the Ctx (osteoclastic activity) to catch it just as it starts going up, about 5-6 months from the last injection, from a low number which you should have being on Prolia. That is when to start Reclast , anyway. But you said you did Reclast and then Evenity, now back to Reclast? I’ve heard after the first time the Reclast gets easier. How did it affect you the first time?

Hi, 255anny I agree with jennirdh about repeating the CTX. Your medications are working as expected.
The doctor who conducted the clinical trials almost never gives his patients the second year of Reclast, as the positive effects endure for two years. With that in mind, you might consider forgoing the second year. But CTX monitoring would be crucial. We don't have your bone density improvement numbers throughout the medications, which would affect your future decisions.
Your medications have been antiresorptives and your CTX looks appropriate.
You might contact the physician in July and ask for CTX and P1NP so you'd have that information for the August appointment. If your CTX has risen sufficiently, another Reclast infusion would be appropriate. I would be wanting to skip the Reclast and start a anabolic--tymlos or forteo at the two year mark August 2026.
CTX is the measurement of a fragment left in the blood when osteoclasts (the acid producing cells) break down bone, which is the initial process of remodeling-- the removal of older fissured bone.
When CTX is high, you can either stimulate the Osteoblasts (bone building cells) or supress the acid producing cells. The osteoblasts are a residue left in the blood when bones are building, measured by P1NP.

Hi - I finished 12 months of Evenity, then 2 months later had the Reclast infusion. Because I refused Prolia, she suggested going back to Evenity after that first Reclast infusion. The Reclast was tough! I had 4 days of horrible aches, brain fog, little sleep. And I stayed very hydrated and took Tylenol the days before the infusion, day of and for 3 days after.

My Dr's suggestion was to return to Evenity after this first year of Reclast. My first OP med was Forteo for 2 yrs, no benefit from that. The Evenity resulted in a small increase of bone density. My DEXA scores are in the severe range, 4.9 spine and 4.3 hip. But my bone "quality" was listed as "good" on the DEXA report.
I feel like I need to get my guns "loaded" so to speak before I see her. But of course she is the expert and I need to listen to her reasoning. That said, I want to get up to speed on all this.

255anny, good thinking. I'll throw some ideas your way.
When I hear about the anabolics not working two things come to mind: first parathyroid and second kidneys.
You may know that your have four parathyroid glands. If even one of them is not working the anabolics won't wore either. The best way to check the parathyroid glands is to image them. This can be the trouble that remains undiscovered with osteoporosis. Kidneys usually announce themselves through lab work.
Even the low response to Evenity indicates that there is an unknown factor draining your bones.
Do you have a before and after density number for Forteo use.
Some experts, especially those obtaining their degrees before 1990, aren't using bone markers. You might ask , at least before and after the first several months of a drug that barely worked in the last application.
I agree that it is important to always listen, listen first and respectfully, to the experts we've engaged.
How can we help to load your guns with good ammunition?

@255anny, I agree with the comments that your CTX result was expected while on a strong bisphosphonate like Reclast. At this level bone remodeling (breaking down as well as new bone formation) is minimal and therefore your bmd is maintained.

When bone remodeling is strongly suppressed by bisphosphonates over a sustained period of time, it is harder for an anabolic such as forteo or tymlos to function 100% as these drugs build new bones requiring both osteoclasts’ and osteoblasts’ activities.

Evenity doesn’t rely on remodeling. However, its effect is also affected by prior use of a bisphosphonate. Here is a publication showing that with prior use of alendronate:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9106644/
This article also provided how bone markers behaved in term of % changes from baseline.

The question for your endo could be, what’s an appropriate level of CTX for evenity to function after a person is treated with a bisphosphonate as strong as Reclast? 100s? 200s? 300s? Or does it matter? I couldn’t find any literature with that information. If the answer is known, then you could monitor CTX to time the start of second round of evenity; or possibly, no timing is needed.

To me, it’s ideal to get bone markers tested when you are venturing with some uncommon route so that you know how you respond to a particular therapy. I believe some of us will cycle anabolic - antiresorptive back and forth several times from now on, instead of using a maintenance antiresorptive for the rest of our lives. It’s imperative to know what worked and what didn’t, and maybe the ‘why’. I understand the drawbacks of bone marker testing. But getting some information is better than no information.

It is worth getting both CTX and P1NP tested at least once before your second round of evenity as a new ‘baseline’.

I and my Dr, both suspect my gut issues contributed to my severe OP. I've had labs run before and after Forteo, Evenity and labs just this past week after my December Reclast infusion. Labs are always normal. I was suffering with SIBO for several years before I knew what it was. I could barely eat. I'm 5'6'' and at my lowest weight I was 98lbs. My normal weight was 120lbs. I'm around 115 lbs now. On top of that issue, I have Diverticulitis flares about 2 times a year. The antibiotics from that contributed to the SIBO in the gut! I am working with a Gastro Dr and he is aware of my OP. My Endo Dr is aware of the gut issues. My current Endo Dr seems up to date on Bone Markers, but didn't request them til I asked for them. My Dr before her, refused to do them. Surprised because he was considered one of the top OP Dr's in the US. (retired now) I know I should be exercising more, meds can't do it all. And I struggle to get solid nutrition because of my gut issues. But I try!! I had a horrible fall 8 years ago which resulted in a broken hip. 2 surgeries later, I have pain everyday and muscle loss. This is all just not fair 🙂

Great help! I like the idea of asking my Dr at what level my CTX should be before starting the Evenity again. But like you said does it matter. And those levels likely differ in all of us.
Totally agree with all your points. I'm taking notes and will get everything together before I see her in August. Thank you for the link.

Why did you refuse Prolia? Doctor want to start me on this, but I am not sure about this also. Please comment if possible.

It was a tough decision between Prolia and Reclast. The rebound issues that surround Prolia scared me. All our situations are different but after much research and reading here, I decided against the Prolia. My Dr pushed it after my Evenity but also suggested returning to the Evenity after 1 year of Prolia. I felt very uneasy with that sequence of meds.