DEXA, BTMs, accuracy and frequency

jozer,
Medicare pays for DEXA every year if my doctor writes a statement of Medical Necessity. Most osteoporosis patients have testing available every two years.
CTX and NTX measure resorption of bone. P1NP measures acquisition of new bone.
These tests should be done in the morning after full fasting for accuracy.
Without a baseline for CTX and even though CTX rose from 52 to 78 we assume with your doctor that Reclast is working.
Without your bone density numbers, it is tough to guess about continuing with Reclast. My suspicion is that you don't need another DEXA. They are less expensive at clinics than they are in hospitals. Their value in comparison is limited if you don't have the two on the same machine.
You might consider that for the many one year of Reclast is effective for two years.
Reclast works by slowing the breakdown and slowing the acquisition, which is why we usually don't have script for the serum acquisition number P1NP with any of the bisphosphonates. t
D3 is more readily absorbed than D2 and is generally considered a better choice.
Magnesium importantly limits the size and shape of hydroxyapatite crystals which gives bone strength and flexibility. You might add magnesium glycinate to your supplements because it also aids digestion.
Your situation is, of course, different from mine. But I would be anxious to take one of the anabolics instead of another year of Reclast. The two pth anabolics work the way our bones naturally replace fissured or weak bone with more speed. The mineral density gained on bisphosphonates is preserved bone, as it preserves that bone that would normally be replaced.
I have no medical background.

My doctor prescribes DEXA scans yearly.

@gently Thank you for this explanation of the different tests available and choice of drugs. It can be very confusing. Have a god day.

Very confusing indeed...and, tillymack, I may finally have to research another doc, bone clinic, etc. as I feel that my current endo isn't doing enough for osteoporosis, not that he is wrong or uneducated but...and as I have read that a lot of us get yearly DEXA (gold standard, so great test right? and how about getting one with TBS) I cannot understand why I can't get one paid for through this doctor. I had to ask for BTMs after initial diagnosis and being on Fosamax for a year, although apparently even doing BTMs is not always done by the doctors. I was told to do weight resistance exercises (like what? I've been doing aerobics with weights for decades) and given a printout of high calcium foods but nothing specific. Told "no benefit" to vitamin K. Vitamin D2 50,000/week for 2 years (finally off that as I have been around 50 for 1 1/2 years and was having side effects from the long term mega dosing). It is just so difficult to go doctor shopping! Gently- thank you much for your insights - always informative; I was somewhat aware that P1NP is more for those of us on anabolic; which are becoming more a first-choice therapy. I however was started on bisphosphonate Fosamax followed by reclast so changing now may be trickier? Since bisphosphonates blunt the effect of anabolic? For me a lot of this is mental health; I am exhausted worrying about my "terrible" bones, how I must be so very careful with every step, change your lifestyle, you could break your leg getting out of bed (!), drugs are NOT pretty, on and on and on! My doctor said that it isn't that big of a deal to get another machine for DEXA; in real life osteo patients move, technicians quit, machines are replaced. Preferred but not required.

@jozer
Just wanted to added that depending on where your osteoporosis is, spine bone turnover happens quicker than the hip area.
It can take 24 months for measurable BMD changes to show on a DEXA in the hip area.
Just something to consider.

I've been on different machines in the past, they took my prior scores and did a conversion to compare them to new machine. It's not an exact method but it was something.

Thanks for the info; I have since learned that my worst score - femur neck - is the slowest to change and in some cases drugs simply do not work at all. I was naive to think that by taking osteoporosis medication I would be on my way to great bone health! And I thought yearly testing would confirm that. Perhaps then the goal is with osteoporosis, numbers not getting worse would be a win. Had slight improvement in all but femur neck on Fosamax but will not know about the effect of Reclast until July 2027. Once we move, I will definitely make sure scores from different machines are considered. And I do understand that change is slow; and for most DEXA every two years, but this information is disappointing; never was made aware of any of this. When I get my next DEXA I want it to be with TBS which is becoming standard at a lot of bone centers, and my current dexa facility does not do TBS (for now), so I will probably have to change machines.