@countryliving That is a much better panel of tests than most of our doctors will order! Surprisingly to me, I see that your doctor has not included Procollagen Type 1 N-Terminal Propeptide = P1NP although CTX = Collagen Type 1 C-Telopeptide has been included. Any chance you can talk your Endo into adding P1NP in? If not you can do self-pay for P1NP as I and others have done.

You can see discussions about the importance of the ratio of CTX and P1NP with some links on this site. Your Endo may be willing to take some of the research papers into account.

Here is the IOF praising and referencing the paper in my next link below.
https://www.osteoporosis.foundation/news/joint-consensus-highlights-role-bone-turnover-markers-osteoporosis-diagnosis-and-management
Update on the role of bone turnover markers in the diagnosis and management of osteoporosis: a consensus paper from The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), International Osteoporosis Foundation (IOF), and International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)
https://link.springer.com/article/10.1007/s00198-025-07422-3
EXCERPT: "We re-affirm the use of serum/plasma tPINP and plasma β-CTX-I as reference BTMs ..."