@redlo I don't think 314 vs. 325 is meaningful. You could well have gotten a different number if you tested the day after getting a 325. These measurements can vary day to day, even hour to hour.

Also, P1NP doesn't always tell the whole story. Nine months after I started on Tymlos, my P1NP had gone up, but not by a ton. McCormick even told me that my DEXA might be disappointing. Instead, it showed a 15% gain. McCormick told me "it's nice to be wrong sometimes." 🙂

@redlo I agree with @njx58 that the most recent P1NP drop is nothing to worry about - a 3% shift could be day-to-day or testing variation. Your formation levels are still very robust. However, the jump in CTX to 1252 is meaningful, it suggests the "anabolic window" might be starting to narrow, but more importantly, any lingering effects of fosamax are finally overpowered by Forteo.

The BTMs proves you are a strong responder. Very likely you have a large amount of newly formed osteoid (soft scaffolding) just waiting to be mineralized. When that happens, your dxa will finally move.

It makes sense to complete the Forteo course, but I also agree it's time to start thinking about a plan B in case your bmd doesn't reach target by the end of treatment. With the help of your endo and McCormick, I'm curious which path you'll end up choosing after Forteo, whether that's extending Forteo, moving to an anabolic-to-anabolic sequence (switching directly to Evenity ), or transitioning to an antiresorptive.

Wishing your bones a massive 'mineral harvest' soon!