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Bone turnover markers (CTX and P1NP): do you have a baseline?
Currently i am on forteo therapy with a couple bone markers tests done. However, I didnt have ctx or p1np tested before the start of forteo as a baseline, regrettably.
It is known that the CTX value varies greatly among different individuals, with a very wide range. For post menopausal women, the range could be 34 - 1037 pg/ml; while for perimenopausal women 34-635 pg/ml. Different labs also have a slight different range values.
CTX, a bone resorption (breakdown) marker, is heavily influenced by a number of factors, such as food intake, circadian variation and exercise/life style, etc.
Bone remodeling is a dynamic and complex process. CTX itself may not fully reveal the whole picture. The bone building marker P1NP, is a lot less influenced by external factors. Taking both into consideration at the same time may shed more lights than looking at CTX or P1NP alone.
For those who had their CTX and P1NP tested before treatment with a bone drug, could you share the results if you don't mind? Thanks a lot!
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@gracie7 you are on the right path... being proactive about your diet, supplements if necessary, exercise and fall prevention is the foundation of management; more importantly, questioning the right drug of choice to start the treatment journey.
Have you had a DXA scan and a FRAX/FRAXPlus risk assessment?
@gently had a great post re bone turnover markers.
Regarding the Prolia recommendation: it's an antiresorptive (slow down bone breakdown) that carries a unique "rebound" risk if stopped. It essentially requires a lifetime commitment or a carefully planned transition to another antiresorptive (a strong bisphosphonate), which adds significant long term complexity. It also complicates future treatment sequencing in the event you need any bone builders. Because of this, it's often not the first line choice -especially when anabolics (bone builders such as Forteo or Tymlos) have shown in several studies to be very effective for corticosteroids induced osteoporosis. Discussing with your doctors about the right drug to start is absolutely crucial, as your instinct tells you.
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2 Reactions@gently, thank you so much for the information. I watched several of his videos and will watch more....very informative. One of the aspects of a med for me is that it isn't a long-lasting med, rather a daily or weekly med so if something isn't working, I am not locked in for 6-12 months and it looks like Forteo would work; however, I have high calcium levels with no supplementation and often deal with pseudo gout so it might not work, but I will ask.
When reading Keith McCormick's book, I think a treatment that slows down bone resorption would create a better balance as my P1NP seems ok, but I am not a doctor so will have to ask that too. Thanks again for your input; this forum is very helpful. Best - Gracie
@mayblin, Thank you! It seems I can't get enough information and you all are wonderful.
I wonder if me now being totally off prednisone, not drinking sodas or taking supplements that I now read increase osteoclast activity and forcing myself to eat much more protein might make a difference in the result??? Along with exercise and weights of course. Best - Gracie
@mayblin, oh sorry, I forgot to answer you. I did have a DXA scan and it showed I was osteopenia everywhere except the left hip which was -2.8. I think the REM scan was more accurate as one outlier of the -2.8 showed an inaccurate result....unfortunately. Thanks - Gracie