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Lessening P1NP (Bone Formation Marker)on Evenity. What to do?
I've just had my 4th Evenity infusion and got the results for the P1NP test (which indicates bone formation). My scores significantly dropped and showed a downward trend, I was on Tymlos and had severe nausea and vomiting so had to quit. I've already had a lumbar compression fracture, so I am in need.
What is working for you all?
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Did you have your P1NP measured before starting Evenity and again during the first few months of treatment (e.g., at 1 month)? If so, was there a big change? P1NP typically begins returning toward baseline around 4-6mo of Evenity treatment.
There are a few members here who have done the Forteo/Tymlos to Evenity sequence, although I’m not sure whether their bone turnover markers were monitored.
I remember reading a paper that discussed bone turnover marker changes when transitioning from a PTH analog to romosozumab (Evenity). If you’re interested, I can try to get the link.
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Hug
3 ReactionsI would really appreciate that, mayblin. Thank you very much!
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1 Reaction@gigilapoisson
https://pubmed.ncbi.nlm.nih.gov/34020048/
This paper is behind a paywall, but the abstract provides the key information.
The attached figure shows the trajectory of bone turnover markers (BTMs) during the 12mo of Evenity treatment (darker solid line). In the graph, months 13–24 represent the follow-up phase with denosumab (Prolia) vs. placebo.
How long were you on Tymlos?
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2 ReactionsWe can get a little fixated on P1NP. We really we need to pay attention to both P1NP and CTX. You don't want to assume that a lower P1NP means that the medication isn't working. If P1NP falls, but CTX falls by a greater percentage, that's good, not bad.
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1 ReactionI was on Tymlos only a couple of months. It gave me severe nausea and vomiting, so I had to quit. Thank you very much for the abstract. I understand that the trajectory will decline over time, but was not aware that it would occur so quickly. I am really wondering what the next step should be?
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1 Reaction@njx58
I agree with your point. It's generally better to look at both markers whenever possible to get a more complete picture of bone remodeling. During early months of Evenity treatment though, the resorption is typically suppressed due to its dual effects on bone remodeling, unless there are other major factors affecting resorption such as coming off Prolia. That early period where the two marker's divergence (p1NP up and CTX down) is the key gauging Evenity's bone-building effect. And as the paper (link above) suggests, the %chg in P1NP and TRAP5b (another resorption marker) at month 1 showed predictive value for bmd gains with pth analog-> evenity sequence.
@gigilapoisson, if you don't have month 1 or 2 P1NP reading to compare with your baseline, and if i were in your shoes, i'd continue and complete the full course. A decline in P!NP after the first few months of Evenity is the expected trajectory and by itself is not a sign of treatment failure imho. I'd discuss with the prescribing physician for assurance and guidance.
@gigilapoisson
Did your doctor try titration (reduced initial dose) until you acclimated to Tymlos ?
No. The initial dose and second dose were full strength.
@gigilapoisson
I’ve read that many have started that way and were able to go to full dose after acclimating without issues…but it seems every doctor has a different idea. Not how it was when I was in medical school.