@osteopatient2026, If the ratio is too low you are likely adding bone that isn't remodeled. Modeled bone doesn't remove the older fissured bone but lays down new bone on top of the older bone.
Some of the modeled bone with the pth drugs is new bone where there was no bone. The drugs can recreated the cartilaginous structure needed to capture calcium to make bone repairing lost trabecular bone.
I haven't read but suspect that some maybe Lucas or McCormick might say that the ratio shouldn't be close. I want my bone markers close and high.
Part of that mindset comes from the time when the only medicine we had to prevent bone loss slowed down bone turnover.
The endocrinologist I see uses bone markers, but doesn't think they can be deciphered in any ratio.
If you haven't you might want to look at what Lucas does with the markers.

Thanks for your kindness. I'm really happy this drug is working so well for you.