Treat to Target -- What is your goal?

It is my understanding that the holiday is dependent on the particular drug and concerns about long term use not improvement.

My goal is to never fracture again. First fracture was in December 2023 and I have avoided another one since. T-score was in the osteopenia range when I fractured so I don’t put much stock in T-scores but it was nice to see that treatment with Tymlos, Forteo, and Evenity improved mine by 30%.

Like oopsiedaisy, my target is never to fracture. And like her, I don't put much stock in T-scores. I trust bone markers, though. Any holiday or drug transition will be because the markers indicate bone loss. Given choice, I won't stop the medication until I'm gone.

@gently

T-Scores matter a lot. Large-scale epidemiological studies have repeatedly shown a clear statistical link between lower bone density and higher fracture probability. Statistically, for every standard deviation decrease in a person's T-score, the risk of fracture roughly doubles.
So someone with a -3.1 to score has roughly double the risk of fracturing than someone with a -2.1 T-score.

However you are correct that bone markers are much more sensitive for catching short-term metabolic shifts (like evaluating a drug holiday or transition) before a DEXA scan would pick them up.

Basically a doctor trained in treating OP would never just use the markers to diagnose, or prescribe drugs, without knowing the T-score.

You are very wise to remain vigilant about the status of your bone health and take medication as your markers and T-score changes. Most osteoporotic fractures are preventable with medication. Good luck on your bone journey.