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@kathleen1314 My low ctx of 80 was considered high by the cleveland clinic and they wanted to put me on Reclast. My P1np was normal, so I declined any drug. My rems test was -2.4 with a normal 37 bone quality which put me at a risk of 1% fracture. What prompted my question was some people on this board had CTX of 800 and up. Again, in the past year my spine went from -2.9 to -2.4 by the Rems test.

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@dvargo
what I am finding is that from your numbers this is likely not caused by "rapid" bone loss (high turnover) but rather a state where the bone remodeling process has slowed down, but the bone density remains low. This can occur due to aging, certain medications (like long-term steroids), or secondary metabolic bone diseases.

The mentioned diagnosis which I saw several times was : Low-Turnover Osteoporosis: This is a specific subtype where bone is not being lost rapidly, but it isn't being built effectively enough to overcome the existing density deficit.

Because this can be caused by other conditions it is necessary to see a good endocrinologist, ck calcium and vit d, and rule out issues like hyperparathyroidism or other hormonal imbalances.

After ruling out diseases or conditions that might cause this:
Some doctors might consider anabolic (bone-building) agents to stimulate new bone formation.
Sorry, I can't remember, did you say you took or could not take BHRT topical/vaginal? I ask because BHRT would probably nudge you towards the build cycle more, as would strontium citrate.