@leslie559 there was a BTM substudy during denosumab phase 3 trial (Freedom) which showed before the second injection, 79% of study subjects still had CTX below the premenopausal reference range - yours is showing just that. This level of suppression is expected and confirms the med is working as intended. That said, the trough CTX does tend to creep up slightly with each successive injection cycle which is well documented. Hope this helps, and you stay on your injection as scheduled.