Value of bone turnover markers

Posted by sebutler @sebutler, Dec 27, 2025

I had thought it would be useful to get reads on my baseline P1NP/CTX as I am finishing Tymlos and just starting a bisphosphonate. But neither of my doctors (a rheumatologist and an endocrinologist) wanted to order these tests -- both said they get them (or maybe just the CTX) after one year on the bisphosphonate. I found that weird since the rheumatologist ordered the measure of these bone turnover markers both when I first saw her and when I was on Tymlos for four months. Have you gotten different recommendations from your doctors??

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gently | @gently | Dec 30, 2025

rjd,
the endocrinologist I'm lucky to see has a more reserved view of bone markers. If I gave him my view of bone markers he might flag my file with some note of caution.
He uses the bone markers before treatment, a month into treatment for bisphosphonates, Evenity and Prolia.
With the pth drugs he uses the two month bone marker. If the medications are working, he writes for six month markers.
I asked for three month markers. When I started my third year of Forteo, he indicated that we didn't need bone markers anymore. At the 3 and a half year years of Forteo he did use P1NP to reassure me that the medication was working still, evidenced by P1NP was double the baseline number, without a glance at CTX.
I'm vested in the markers for various reasons that might make the doctor laugh. He doesn't think that the markers have use in comparison to each other, which is one of my opinions ( or delusions).
The accepted value of bone markers is in treatment initiation to ascertain that the drug works for the individual. I wish markers were more commonly used to chart protection from Prolia rebound. And think it e essential to determine IF a patient should take a second year of Reclast after the first.
IOF guidelines still cite bonemarkers as useful for "certain" unnamed patient populations.
I am still looking for what might be the best medical citations hopefully from pubmed to sway your doctor.
I have found that most doctors don't appreciate research input from their patients.
It's good to question everything that I write. I may have to abandon my own ideas. Maybe, after my March dexa I'll realize that I'm the victim of an elaborate four year hoax just in time for April 1st.