Blood Marker Testing

What were your readings, if you don’t mind sharing?

McCormick uses them for comparisons. My doctor doesn't use them at all and says there could be an entire conference on this issue.

Mine never really matched up with what seemed to be going on with my bones! These are complex matters and I don't think a lot is known. My doc says bone markers don't tell the whole story of what is going on.

Other doctors do rely on them. @babs10 did you have baseline values or are these baseline? I missed my chance!!

@mayblin

Here you go!

Alkaline phosphatase, Bone specific 16.2
P1NP 62
CTX 342
Phosphate (as phosphorous) 4.1

@windyshores, These are the baselines.

@babs10 your baseline bone markers are indeed unremarkable. If these were my numbers without having a high frax score, I’d wait and repeat a yearly Dexa, with tbs preferably. Make sure fall prevention as a top priority during the interim. Your last Dexa doesn’t show a typical bone loss pattern due to estrogen deficiency. I found your hip readings puzzling. One of my relative has normal spine bmd and tbs reading but hip t score at -2.2, strange too. Waiting to see a specialist but it’s 8 months away.

I remember you are going to repeat a Dexa with a tbs soon, right? That’s a good idea. Once you find the right facility/machine, you’d have a good base Dexa for future comparison.

@mayblin, When a person has OP are these baseline scores usually abnormal? According to the Sheffield FRAX assessment tool, my risks:
Major osteoporotic 12
Hip Fracture 2.4

I have called so many places in and around Denver but haven't found anywhere with TBS software. I have a handful of other places to try.

Any guesses on my hip or your relative's? I didn't know the spine/hip discrepancy was unusual until you and a few others on Facebook recently mentioned it. The MD was non plussed about it so I don't know what to think!

The same day I got the blood test results back, I got a call from an infusion center to set up an appointment for Evenity injections. I am so far from deciding on a medication (if I end up taking one) that I was shocked. I will call Monday and get a follow up appt with the MD.

Thanks for weighing in.

My bone markers have always been in normal range for my age but I have 7 spinal fractures.

@babs10 the etiology of osteoporosis is heterogenous, even among post menopausal women. Some op patients could have more than one cause. For those who develop op mainly due to estrogen deficiency, most of time we will see a higher CTX reading which could be within normal range. Only ~20% op patients have a CTX higher than 800, while very few have a CTX below 250 (comparing heathy young women: 50% below 250 and 50% above 250). Bone markers definitely are not a tool for diagnostic purposes. Both your CTX and P1NP are reasonable presently, but we don’t know your past readings as first 5-10 year after menopause women tend to lose bone fastest. There might be reason(s) other than estrogen deficiency causing your hip bones bmd loss over the years. I’ve read that natural bone structure, prolonged sitting, abnormal mechanical stresses as well as blockage of small blood vessels around hip, etc. could all be the causes of bone loss around hips.

The discordance between your hip and spine Dexa readings belong to minor “low hip discordance”category (osteoporosis hip vs osteopenia spine), proper treatment should be oriented to the hip. There was a small study showing low hip discordance among the BMD discordance types is a risk factor for hip fracture. If wait and see approach is elected as Miller recommended, preventive measures for hip fracture become necessary.

@mayblin, Interesting. Thanks so much for laying all of that out. Dr. Miller shrugged and said that it could be microstructure of my hip and this may be the way I was born. I was surprised to get a call from the infusion center without having another discussion with him. I don't think I am a candidate for Evenity (not covered by medicare by the way, but neither is Tymlos) because I was diagnosed with a blood clot in my 20s and I have high blood pressure (controlled by low dose meds). It's not from prolonged sitting, that I know. What would be an example of an abnormal mechanical stress?

I'm off to read T-score discordance between hip and lumbar spine: risk factors and clinical implications and hope I can decipher it. I have trouble understanding these studies! Opening commentary: "T-score discordance is common in osteoporosis diagnosis and leads to problems for clinicians formulating treatment plans." Great.

Just read a bit. How do you know if this is a minor discordance vs. major? TIA

Thanks again.

@babs10
the normal range is so broad that I haven't seen any numbers in the literature where an osteoporosis patient was out of range. The scales are 20 years old and were developed by the assay labs and adopted by medical providers.

From what I've observed (from my own dxas and from reading) women lose the most estrogen and bone in the first 5 years of menopause. Bone markers would be of value then. There should be a separate range for women from 50 to 55. Speculating; when you first lose bone your bone markers rise. After bone loss your markers will settle back down because you are not building bone. Where bone is lost blood supply and nerve supply are also lost. Without intervention your body hasn't a way to rebuild the bone. Your serum levels of markers reflect reduced rebuilding.
Before Forteo, the only way to medically address osteoporosis was by reducing osteoclasts. Bisphosphonates were the medication we used. Osteoclasts were maligned, undeserveably. Lower really isn't better. More commonly. now, bone specialists are saying that it is best to raise osteoblasts than to supress osteoclasts, especially in osteoporotic women. Reduction in bone formation is the primary reason for age related bone loss. Turnover is said to increase by 50 to 100% within the first years of menopause because of the loss of estrogen. It's higher in a desperate attempt to save those bones.
So babs, your bone markers look perfect.
The bone markers will be of benefit to measure the effect of medications. With Forteo or Tymlos markers are best taken at 2 month not 3 as is common.
Best use for bone markers has not been sufficiently explored.