Evenity and Bone Markers

Hi @kristie2 , I likely will move from Prolia to Reclast once I achieve my targeted T-score on Prolia. Knowing that I will have a rebound of about 1/2 of a T-score when I stop Prolia (after many years), my target for spine will be -1.5 to -1.0 before I switch.

That’s a great goal !

Now I remember that you and I corresponded before I began Evenity. I, too, have high urine calcium (apparently idiopathic). If i recall, you didn’t have much gain on Evenity?

Well, that's a long story. As it turns out, I actually had pretty good response on Evenity. They messed up my first DXA scan and scanned L2-L5 instead of L1-L4. All said, I gained about 11% BMD in the spine and about 5% in the hip. Since I lose both calcium and phosphorus in my urine, I supplement both to try to keep serum levels where they need to be. I'm still working on the root cause and it seems to be a kidney thing. My 1,25(OH)2 vitamin D is also too high as well as my FGF23. It's pretty complicated. 🙂

@windyshores

You have been so informative in so many ways! My current situation is that I have been on Tymlos for about five months. My current pen runs out in days. Our insurance company (commercial) changed with the new year, and the new company is denying the necessity of Tymlos, wanting me to use a bisphosonate. Conversations are taking place to try to get them to reconsider (long process and many layers of people). Also, the doctor I was seeing in the practice left for another part of the country, and I have a doc that is new-to-me in the practice (and she is an osteoporosis-concentrated doc). She wants me to see her in mid Feb (first available I guess) and do labs prior “to see if Tymlos is even working”. Labs include bone markers, which I assume is what she will focus on. I did have all this done prior to beginning Tymlos. She declines giving me one of their sample pens so I will not have to discontinue treatment. So it appears she too is questioning my need for Tymlos……(or they want to save them for people in greater need and risk, which I understand).

I have scheduled my labs asap, so if being off the med adversely affects the markers. But is it reasonable to hinge my treatment plan on bone markers five months in? (I know you are not a doctor, and I will not quote you or in any way consider you responsible for anything. I just am wondering how reasonable this is and if I should question it). I am 62, in great health aside from this. Spine dexa the worst at -3.6, but no fractures. I do have probs with acid reflux, and that is why my PCP said I needed to see an osteo doc, as she can’t prescribe other than old school stuff. Thx to you and anyone else who can comment.

@windyshores - while this is an old thread, but it's new to those of us who are just now asking these questions. Hopefully this article wasn't already referenced, but I found it informative as I anticipate the end of the Evenity course & plan to have BTM checked at the end, 4-mo later & then perhaps 4-mo later to evaluate my progress going forward. Fortunately, my next DXA is scheduled a month after my last Evenity injection. The dr has not checked BTM during the course & sees no reason to at this point b/c the DXA will give her all she needs. I will ask my PCP for the BTM or will self-pay to track my progress:
https://melioguide.com/medications/evenity-a-physicians-perspective/
From the article:

EVENITY’s effect on bone turnover markers looks different from the other anabolic agents. With Forteo and Tymlos, both P1NP (a marker of bone formation) and CTX (a marker of bone resorption) rise. With EVENITY, P1NP rises while CTx decreases, reflecting its unique dual action: promoting bone formation while simultaneously reducing resorption, without directly stimulating either side of the remodeling cycle.

I've been on Evenity for 6 months. I just had labs drawn and my CTX went up from a baseline of 191 to 457. The P1NP rose from 89 to 100. I'm seeing my doctor in about 10 days so I'll see what she says about this.

What is CTX? And PINP?

@followheart87 The rule of thumb some docs follow, based on research & number-crunching) is to.maintain a P1NP : CTX ratio greater than or equal to 150 (meaning you are anabolic...aka in a building bome state). (Recent talk has dropped that to >= 130. Your ratio is 219 = 100 ÷(457/1000). Great!!

@cathyf31
Thank you, this information is helpful, I wasn't aware of the ratio.