Connect
High Turnover Help - Understanding my CTX/P1NP Ratio
Hi everyone, I’m trying to make sense of my recent labs and T-scores. I’ve been following Dr. Doug Lucas (not officially joined his OsteoCollective) regarding bone turnover markers, and here is where I stand:
• T-Scores: -4.2 (Vertebral) and -2.9 (Femoral)
• CTX: 585 pg/mL (High resorption)
• P1NP: 128 ng/mL (High formation)
• Calculated Ratio: 218 (P1NP/CTX x 1000)
My understanding is that a ratio >149 is the goal, so I'm encouraged that my bone formation marker is high, however my bone resorption is also very high.
Has anyone else dealt with high turnover markers like this?
Thanks for any insights!
Like
Helpful
HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
Connect
@vegada Please let me know how it goes! I’ve become increasingly frustrated with how often conventional medicine focuses on managing symptoms instead of truly looking for root causes. That realization is actually what inspired me to start the journey toward becoming a board-certified functional nutrition practitioner. I just started school and I’m so excited about this path not only to continue healing and learning for myself, but to eventually help others uncover root causes and live their healthiest, fullest lives.
@br03 They is terrific! Good for you. Congratulations on taking this incredible path. I am so happy for you. 👏🏻👏🏻👏🏻👏🏻👏🏻
@br03
Wow, what doctor did the GI-MAP test and baseline hormone labs for you. Were these the DUTCH labs?
THank you for a great reply!
@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.
@vegada, in chronic kidney disease stage 3b or higher, CTX can sometimes be higher and harder to interpret.
Are you currently on an aromatase inhibitor as part of breast cancer treatment? That can also increase bone resorption marker CTX.
-
Like -
Helpful -
Hug
2 Reactions@kathleen1314 It was my functional medicine provider. The GI Map test was from Diagnostics Solutions and baseline hormones and cortisol were through Evexia Diagnostics and my organic acids test was also through Diagnostic Solutions.
-
Like -
Helpful -
Hug
1 Reaction@mayblin Thank you for your response. In 2020 (baseline) my CTX was 350. My last one in 2024 was 254. I do not have a baseline for the P1NP. Thank you, also, for the comment to avoid collagen prior to test. I didn't know that.
-
Like -
Helpful -
Hug
2 Reactions@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.
-
Like -
Helpful -
Hug
3 Reactions@mayblin yes I am and have been on Anastrozole for six years. I have one more year to go on Anastrozole and then will be done. Any idea how much an AI impacts the CTX? I read that kidney disease does impact CTX but not sure how much it does. Thank you for responding and sharing this information.
@vegada
Anastrozole reduces estrogen production. Since estrogen normally helps suppress bone resorption, lower levels can lead to increased bone breakdown and a higher CTX.
CTX is also cleared by the kidneys. In moderate to advanced chronic kidney disease, reduced kidney function can result in higher blood levels of CTX due to its lowered clearance.
In addition, the kidneys are responsible for converting vitamin D to its active form. When this capability is impaired, it can lead to secondary hyperparathyroidism, which may further increase bone turnover and CTX. However, your normal PTH and vitamin D levels make this less likely to be a major contributing factor.
Hope you’re able to navigate your health challenges smoothly going forward. Best wishes!
-
Like -
Helpful -
Hug
2 Reactions