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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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@alit
I agree with @gently, your CTX results is a bit unusual for someone on Evenity. Usually, CTX goes down below baseline while on treatment and doesn’t rise above it until after the therapy ends.
Timing of lab, fasting status, even which lab was used can affect the results. Other factors, like recently stopping Prolia, healing from a fracture, or having had (bone) surgery, etc., can also affect CTX.
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1 Reactionhi mayblin.
I remember reading about people who'd had no bmd gains on Evenity. I don't think they had bone markers. alit is experiencing an awfully big jump in CTX on Evenity. P1NP looks right. Because sample prep is so complex with CTX, it seems like it must be lab error. But would you repeat both labs?
@gently
If I were the patient, I'd request a repeat lab for both markers. That said, bone marker activities tapers off after about 6mo of evenity. The bigger question to the doctor is whether a confirmed jump in CTX would actually change treatment plan. I think it's worth keeping an eye on and maybe checking for other possible causes.
Do you happen to know why some people don't respond well to evenity, based on what you've read?
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1 Reaction@kristie2 - I've been on conservative doses of Pro & Est for many yrs. Now I need them increased to address BMD. Thanks for the info you've provided. I'm on the Evenity injections & will be seeing a new Dr who knows about BHRT for those w/OP. It's been a challenge, as so many are addressing peri-menopause w/symptoms being part of the evaluation. Hopefully my new Dr will be able to accommodate my desire to impact bone quality. It's getting expensive to pay for New Patient fees as a cash-patient--argh!
@mayblin
thanks, mablin.
Low P1NP at one month would be indicative, but we don't have a one month. It seems like no one is wondering about the 2+% who don't respond. I'd guess that the P1NP is assurance of response?
@alit - did you also stop any of your other supplements before the blood lab? I take the same amount of calcium & Vit D as you do while on Evenity injections for 5-mo so far
@alit
58-f002/https://pmc.ncbi.nlm.nih.gov/articles/PMC12072299/figure/jcm-14-02
Will your doctor weigh in on these markers?
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1 Reaction@singingbones Yes I’ve had to pay out of pocket every 3 1/2 - 4 months $350. For my hormone therapy of biote.
@kristie2 - I'm still educating myself re: biote. Not sure what this new dr will recommend. But I've already spent so much money as a New Patient in several offices. I wish drs would have a realistic fee for a 20 min consultation/interview so that a patient can decide if they are in agreement their approach/philosophy. Most of the time the person answering the phone is not that helpful. Anyway, I do understand.
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1 Reaction@kristie2
What is biote?
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