When to check bone resorption/formation markers?

McCormick told me today that on bisphosphonates, you just need the CTX. Three months is good.

That makes sense. Thank you for the info 🙂
I hope this time CTX will be lower. Some months ago (before treatment) it was quite elevated. If I see that it has decreased, that will give me some hope and motivation.

@windyshores, that's great you are consulting with Keith McCormick. :).

@alexxa I have seen him from time to time for a few years. My talks with him supplement my endo and generally they agree, but my endo doesn't do blood tests.

Right now, close to two years point, Tymlos is no longer growing bone but holding me steady. My kidneys are better so I will go ahead and schedule a 20% dose of Reclast and I got approval for IV saline hydration. Endo says to call after a month with a dose I want at the 3 month point after Reclast test dose; McCormick suggested doing 20% every time. We'll see how my kidneys do!

Hi windyshores! I am uncertain about taking Evenity as my endo has recommended and have postponed the infusion until Oct. 4; since I have a history of a malignant sarcoma that occurred twice (1983 and 2004) cancer potential bone builders are excluded, but my endo sees Evenity as okay; I was looking for your comments on alternatives to Evenity, or maybe even a holistic approach instead. I have a notation for your July 19 comments about this but am having trouble finding it. Could you help me find it and/or suggest best alternatives for my case. My blood tests are all okay, I am 82, and have a T score of -3.8 for spinal verterbrae and pelvic bone. I have never had any bone building meds but am taking caltrate now.

As far as I know, Evenity doesn't have the same concern for recurrence of sarcoma as Forteo and Tymlos. The black box warning for those drugs about causing bone sarcomas was lifted but the caution for those who have already had a sarcoma is still there. I don't see anything in the insert for Evenity on this: the warning is about heart attack, stroke, cardiovascular events (and the difference between Evenity and placebo looks small).

From the info online it looks safe. It is hard when our endos don't know cancer and our oncologists don't know bones, but you can ask them of course. I often find that pharmacists are good for these questions and even calling Amgen, the manufacturer.

I have to wonder about the effect of bone builders on those with blood/bone cancers such as CLL. I want my watchful waiting period to extend as long as possible. I would like to stay at stage 0 for many, many years and never need a bone marrow biopsy.

Thank you so much! Your insights are VERY helpful. Added to my concern, when seeing my GP about a small issue of a skin patch, we noticed a suspicious mass on my arm. So everything will be postponed for this mass to have an ultrasound. But your suggestions to consult both pharmacist and Amgen are certainly worth doing. And I shall, after the ultrasound, which will hopefully be a non-issue.

Interesting that your endo doesn't do the blood tests. I am about 2/3 of the way through Dr. McCormick's book and was quite interested in the blood work he recommends. When I went for my 6 mo. Evenity shots at the end of August, I was told I had to have blood work done before the shots. I asked what they were checking for. CTX and P1NP were not included. I called the doctor who initially recommended Evenity treatment for my osteoporosis, and the response I got was that they no longer do those tests and was not given a satisfactory reason why. Now I am really confused. Obviously, you can't get blood work done without orders. I see my PCP next month for my yearly and plan to discuss that with her.

@mao22 I get my PCP to order CTX and P1NP and then talk to McCormick. My endocrinologist told me there could be an entire conference on the issue of blood tests and that the field is really split. McCormick told me there are inconsistencies in benefit because docs don't know how to use them: they should be fasting and done at the same time in the early morning for comparison (especially the CTX, as I remember, but could be wrong).

I got a second opinion endo who does do the testing but I have seen my main endo for years and years and he is in my hospitals system so for now I am using PCP to order the tests.