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

I see. Below is a chart for the percentage changes of P1NP and CTX during 12 month romosozumab (Evenity) treatment, data from its phase 3 study. It looks like the best time to see bone formation marker P1NP surge is during first two months, you might have missed it due to timing, although a concurrent HRT might affect bone markers response.

Curious, has your prescribing physician for HRT discussed various dosage forms for estradiol? Many obgyn prefers transdermal form nowadays due to the benefits of lower risk of blood clots (by bypassing liver’s first passing metabolism) and a more stable hormone level, among others. You might want to ask. From what I read, 1mg oral tablet is approximately equivalent to 0.05mg/day transdermal patches of estradiol.

My last prescription from my GYN was written on his last day before retirement so I’m still in search of another GYN. My PCP can cover the med portion, if I ask him about it. The only difficult part being is he believes the Estradiol is not beneficial for me, so I’m not sure he would be on board with prescribing any. But in my 25 yrs of being on HRT none my GYN’s or my ND (BHRT) talked about doing a cream. Food for thought though, thank you

Both of my numbers went up.
Before Forteo (August '23) they were P1NP: 45.9 and CTX: 444
6 months after started Forteo (April '24) they were P1NP: 220 and CTX: 1293
I am asking here for advice about these results. as I'm not sure either. I should have put in also that I had a compression fracture in spine in March and another in Sept. so that may also have had an effect on the numbers?

My numbers were very similar to yours! I didn't have a baseline CTX, but my P1NP before Forteo was 32. After 12 months it was 135. Mt CTX after 12 months was 1355! But I didn't know about not exercising before the test. Between that and being on Forteo, my Dr. was not concerned. Hope she's right!

@nwyatt, did you get a Dexa scan after 12mo on Forteo?

No, I have to wait one more year because of insurance coverage.

The bone markers while on Evenity were spot on to the trials. Below is a snapshot. While CTX is lowered on Evenity, it is not near as low as on Prolia.

Since my T-scores are still very poor, my only choice after Evenity was Prolia. A bisphosphonate would not be able to get me into a safe zone and I really don't think Tymlos or Forteo would work out for me. That said, I am considering combination Prolia + Tymlos. I will wait a year to see how Prolia is doing on its own first.

Hi mayblin, I believe I have high baseline CTX from my hypercalciuria. I'm was peeing out more calcium than I could absorb in a day. While I have lowered urine calcium, it's still way to high at about 350mg/day. I'm still trying to track down the cause. Hopefully this year I will be able to figure it out.

I did not have good outcomes on Evenity. I gained only about 2%. I believe that the results are again related to my high urine calcium. You can't build bone if your net daily calcium is near or below zero.

Prolia seemed like the right choice if not the only choice after Evenity for me. Fingers crossed I can tilt the calcium balance in my favor and see some improvements. I'm taking in about 1500mg or more calcium per day.

Thanks for asking. I have appointment this year with the best nephologist and endocrinologist I could find. They should be able to help me more.

Mike

Mike,
I was on Evenity for one year T score in spine -4.6 . Then after one year T score -3.3. Then I was put on Prolia and after one year T score 3.2. My endocrinologist now suggest Reclast basically no change. Can you please give me your insight on switching at this time to reclast ?