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Bone turnover markers (CTX and P1NP): do you have a baseline?

Posted by mayblin @mayblin, Mar 27, 2024

Currently i am on forteo therapy with a couple bone markers tests done. However, I didnt have ctx or p1np tested before the start of forteo as a baseline, regrettably.

It is known that the CTX value varies greatly among different individuals, with a very wide range. For post menopausal women, the range could be 34 - 1037 pg/ml; while for perimenopausal women 34-635 pg/ml. Different labs also have a slight different range values.

CTX, a bone resorption (breakdown) marker, is heavily influenced by a number of factors, such as food intake, circadian variation and exercise/life style, etc.

Bone remodeling is a dynamic and complex process. CTX itself may not fully reveal the whole picture. The bone building marker P1NP, is a lot less influenced by external factors. Taking both into consideration at the same time may shed more lights than looking at CTX or P1NP alone.

For those who had their CTX and P1NP tested before treatment with a bone drug, could you share the results if you don't mind? Thanks a lot!

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mayblin | @mayblin | Aug 2 11:03am
In reply to @singingbones "@kristie2 - are you using BHRT as a sole follow-up to Evenity? I have recently finished..." + (show)
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@kristie2 - are you using BHRT as a sole follow-up to Evenity?

I have recently finished the Evenity course and will check BTMs next week (self-pay as dr trusts only DXA). Unfortunately, the only baseline I have is prior to Evenity, but at least it's something even though I was not counseled in regards to proper preparation. So my labs next week will sort of set a new baseline for me. I assume there will be some Evenity properties still in my system to impact the results, but then I'll get the BTMs done every 3-months until I see a pattern emerge.

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@singingbones
If you finished your 12th Evenity injections about a month ago, then your upcoming BTM results will provide a useful new post-treatment reference point. You can compare them with your pretreatment baseline (before starting Evenity). although as you mentioned, that baseline might not have been ideal.

According to the clinical trial data and the manufacturer’s prescribing information, “After discontinuation of EVENITY, … CTX increased above baseline levels within 3 months and returned toward baseline levels by month 12”, as shown in the attached graph - I circled the CTX uptick in red.

If you are open to sharing, I’d be interested in seeing your BTM trend. Thanks.
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singingbones | @singingbones | Aug 2 4:39pm
In reply to @mayblin "@singingbones If you finished your 12th Evenity injections about a month ago, then your upcoming BTM..." + (show)
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@singingbones
If you finished your 12th Evenity injections about a month ago, then your upcoming BTM results will provide a useful new post-treatment reference point. You can compare them with your pretreatment baseline (before starting Evenity). although as you mentioned, that baseline might not have been ideal.

According to the clinical trial data and the manufacturer’s prescribing information, “After discontinuation of EVENITY, … CTX increased above baseline levels within 3 months and returned toward baseline levels by month 12”, as shown in the attached graph - I circled the CTX uptick in red.

If you are open to sharing, I’d be interested in seeing your BTM trend. Thanks.

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@mayblin - thanks for this add'l piece of information regarding the impact of Evenity on BTMs. I'll post when I get the results with a summary of all the variables and moving parts that will make it a little more challenging to interpret. But, no matter what, I need to monitor my journey in some tangible way between DXA scans and the pressure to take on another bone drug.

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singingbones | @singingbones | 5 days ago

@mayblin - here's my convoluted, less that ideal BTM, Evenity, HRT, BTM journey so far:

July '25 (prior to Evenity) - P1NP: 34 CTX: 444 (fasting, but not informed about avoiding biotin or collagen)
July '25 - begin Evenity (spine -3.5; hips both -2.8)
Apr '26 - begin HRT
June '26 - last Evenity injections
July '26 - DXA: spine 1.0; hips -1.9 (great improvement after Evenity)
Aug '26 - P1NP: 21 CTX: 177 (different lab, fasting, early morning draw, no biotin or collagen)

As we've discussed, BTM have their own unique pathway following Evenity. I don't know if the HRT would have had much impact from late Apr to early Aug. No BTM were taken during or after the Evenity course except for the self-pay ones that I'm reporting right now.

I suspect that Evenity is still being reflected in the BTM results (I saved the chart you sent). At least I'll have my own baseline to work from as I consider another draw 3-mo from now and then again 6-mo until I see a pattern emerge.

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mayblin | @mayblin | 4 days ago
In reply to @singingbones "@mayblin - here's my convoluted, less that ideal BTM, Evenity, HRT, BTM journey so far: July..." + (show)
Profile picture for singingbones @singingbones

@mayblin - here's my convoluted, less that ideal BTM, Evenity, HRT, BTM journey so far:

July '25 (prior to Evenity) - P1NP: 34 CTX: 444 (fasting, but not informed about avoiding biotin or collagen)
July '25 - begin Evenity (spine -3.5; hips both -2.8)
Apr '26 - begin HRT
June '26 - last Evenity injections
July '26 - DXA: spine 1.0; hips -1.9 (great improvement after Evenity)
Aug '26 - P1NP: 21 CTX: 177 (different lab, fasting, early morning draw, no biotin or collagen)

As we've discussed, BTM have their own unique pathway following Evenity. I don't know if the HRT would have had much impact from late Apr to early Aug. No BTM were taken during or after the Evenity course except for the self-pay ones that I'm reporting right now.

I suspect that Evenity is still being reflected in the BTM results (I saved the chart you sent). At least I'll have my own baseline to work from as I consider another draw 3-mo from now and then again 6-mo until I see a pattern emerge.

Jump to this post

@singingbones
I’ve replied here - https://connect.mayoclinic.org/comment/1643074/

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