High Turnover Help - Understanding my CTX/P1NP Ratio

to clarify the posting information:
Are you currently taking any osteoporosis medications or have you had a recent fracture?

No, not taking any osteoporosis medications. I had a recent vertebral fracture T 8/9 in late October which is what started this whole process of getting the DEXA and discovering I have severe osteoporosis.

@kathleen1314 No, not taking any osteoporosis medications. I had a recent vertebral fracture T 8/9 in late October which is what started this whole process of getting the DEXA and discovering I have severe osteoporosis.

@br03
Sorry more clarification:
Have you already had bloodwork done to check your Vitamin D and Parathyroid Hormone (PTH) levels to rule out those common drivers of high bone turnover?

That fracture could be driving elevated bone numbers or secondary causes which I am assuming your endocrinologist is investigating. Discuss with your doctor if high turnover might be driven by other factors like hyperparathyroidism, thyroid issues, or Paget’s disease, especially given the very high absolute values.

Basically, you are ruling out causes and then you will be left with a clearer idea of how to proceed.

Also....
As the body heals a fracture there is frequently something called : The "Fracture Effect": A bone fracture significantly spikes both resorption and formation markers as the body attempts to repair the damage. P1NP and CTX typically peak around 6 to 12 weeks post-injury and can remain elevated for up to 6 months. Since your fracture was in late October, your current high levels may largely reflect this active healing process.

@kathleen1314 Thank you for sharing this information. I wasn’t familiar with the “Fracture Effect,” but it makes a lot of sense. I’m currently working through lab testing to better understand the root cause. I know it’s not hyperparathyroidism, and my vitamin D levels along with several other micronutrients are in a good range.

I suspect this may be connected to my ongoing gut issues. I recently completed a GI-MAP test and am waiting on those results. My goal is to manage this without medication if possible, so I’m diving deeply into the research to better understand my options. I’m truly grateful for this group, I’ve already learned so much from everyone’s shared experiences.

May I ask, what is P1NP?
Thank you.

@br03 Did you ever find out why your markers were high? Mine are very high as well. My CTX is 1,340 and my P1NP is 87. I don't have any fractures. I had prior breast cancer six years ago. My Vitamin D and PTH are normal. I have osteopenia with my left femoral neck on deca at -1.4 and lumbar spine at
-1.8. I also have chronic kidney disease stage 3b. Does anyone have any idea why my markers are so high?

@vegada Thanks for checking back in. I’ve learned that the biggest driver of my bone loss appears to be related to gut health issues and chronic systemic inflammation. I’m also postmenopausal, but because of the findings from the Women’s Health Study, my doctor had not previously recommended BHRT. I eventually pursued additional testing, including a GI-MAP test and baseline hormone labs, which helped identify underlying concerns and led me to start BHRT.

I know this approach may not be an option for everyone, but I highly recommend considering a functional medicine provider if possible. They can often help look more deeply at root causes rather than just managing symptoms.

Hi! I just had my CTX and P1NP blood tests after 3 months on Tymlos. CTX score = 895 and P1NP = 141. One thing I did not do was to fast for the CTX test as I was not advised to do by my Endo. I am taking both tests over this coming week.
I was told these numbers but are they? I have read a bunch and just don’t know. Now my endo did not tell me to get these tests done. I asked for them through my Primary. It’s a hard relationship with my Endo as she does not reach out to discuss these scores. Pretty frustrating.

So any thoughts on these numbers? I have read that a CTX this high could mean susceptible to fracture.

Any thoughts are welcome.

@br03 thank you very much. I also agree that a functional medicine doctor is an excellent idea. I will check into getting an appt. tomorrow.