@loriesco That’s a fair perspective, and it does line up with what that paper is saying. BTMs like P1NP and CTX aren’t critical for diagnosing osteoporosis, and they’re not something every patient needs.

Where they can be very helpful is on the management side. They give earlier feedback on whether a treatment is having the expected effect, which can be useful in some situations especially when you don’t want to wait a year or two for changes on a DEXA scan. But even then, they don’t always change what a doctor would do, which is probably why some clinicians don’t rely on them heavily.

So I’d agree they’re not essential, and I still think they can be a useful tool in the right context. It probably just depends on the individual case and how much that early feedback would actually influence treatment decisions.