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@mayblin Thanks for finding these references!
I'm using Zometa (the 4 mg dose instead of the usual 5 mg Reclast dose/infusion) which was prescribed by my oncologist. Following my breast cancer diagnosis in the fall of 2024, I started on an aromatase inhibitor, letrozole, in July 2025. Because 1) that drug can lead to serious bone loss, 2) my FRAX score was relatively high although my 2025 Dexa given before I started letrozole showed osteopenia and not osteoporosis, and 3) my age of 75, my oncologist recommended I start osteoporosis medication. I could not take oral bisphosphonates, didn't want Prolia, and my estrogen-positive breast cancer ruled out anabolic meds. Hence...the Zometa.
The Zometa did what it was supposed to do in reducing my relatively high CTX at baseline but it has gradually crept back up above that 280 threshold. I, however, look at how much the CTX came down from baseline. Yes, it is going back up but I'm not sure how quickly. My endocrinologist won't order another CTX because she think it's pointless. I disagree and may order labs on my own. I'd rush out and do this except I'm a tough needle stick. The last time Quest Labs tried to draw blood, they couldn't. I usually rely on my port but that means labs only ordered by my oncologist or other doctors at the same medical center.
My endocrinologist did order another Dexa and it will be a little more than a year since the 2025 one. Unfortunately, everything I've heard that Medicare probably won't pay for the Dexa this time since it's under the 2 year interval. I know others on this site say they have been approved for Dexas sooner than every 2 years, but their diagnostic codes may be different than mine.
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@prarysky, i see. It sounds like your doctors are using Zometa to manage your aromatase inhibitor–associated bone loss (AIBL). From what I've read, the most commonly studied approach is 4 mg every 6mo; 5 mg once a year is also used as an osteoporosis-dose approach in some guidelines, with DXA checks every 1–2yrs and reassessment.
I think using CTX to individualize the timing of the next dose is a thoughtful approach, since a single zolendronate infusion can keep bone resorption suppressed for many months, and sometimes considerably longer, based on studies.
Since you're dealing with AIBL rather than Prolia discontinuation, the CTX uptick here reflects a combination of the zoledronate gradually wearing off and letrozole continuing to push resorption upward - a different situation from the marked rebound that can occur after stopping Prolia. So it makes sense that your endo is using CTX as one piece of information to individualize when another Zometa dose might be needed.
I really hope you can get labs ordered that work with your port - that would make everything so much easier. I know how much more assured you’d feel just knowing where the CTX stands. Ugh, being a patient is already hard enough without these extra barriers. You’re dealing with a lot all at once 🫂