@yogagirl57
Do you happen to have your baseline CTX and P1NP tested before starting Tymlos? That would help show how you’re responding, especially the change in P1NP from baseline.

CTX can increase during Tymlos therapy as well, but an increase in CTX alone does not necessarily mean higher fracture risk.

For best comparison between tests, CTX is ideally done 10-12hr fasting, and in the early morning. It’s also best to avoid biotin or collagen supplements for 24–72 hours before labs and keep the timing of the blood draw consistent.

@yogagirl57 I had baseline CTX and P1NP and then 3 months into Forteo, which like Tymlos is a PTH analog. I relied on AI to explain the meaning of my bone markers after 3 months of Forteo. Since this is an AI generated answer, you may want to take it with a grain of salt, but what it said was that increased CTX is normal in the early stages of treatment with teriparatide. A higher CTX number after 3 months on teriparatide is expected because this medication primarily stimulates bone formation, which initially leads to a temporary increase in bone resorption (as measured by CTX) as the body starts the remodeling process to build new bone, even though the net effect is a gain in bone density over time; essentially, teriparatide "primes" the bone to rebuild itself by increasing bone turnover, resulting in a higher CTX level early in treatment. When monitoring P1NP levels while on Forteo (teriparatide), a significant increase of more than 10 µg/L from your baseline level after 3 months is generally considered a positive response, indicating that the medication is effectively stimulating new bone formation; this is often used as a benchmark to assess treatment efficacy.