With a low baseline CTX would an antiresorptive be contraindicated?
Does the pharmaceutical choice determine the frequency of bone marker testing? Mayblin?
My CTX is low. One doc says studies show no difference in outcome when going on Reclast with low CTX after Evenity. McCormick says to test and wait. Other doc doesn't test at all but waits 3 months between Evenity and Reclast for mineralization to complete.
Over suppression of turnover is a concern expressed by McCormick, yet this is how anti-resorptives work. I plan on asking my doc about this.
Look forward to any info here. We need more research and consensus!
@gently, I’ll try to answer your question with the knowledge I gathered so far.
The short answer is: with a very low CTX baseline for a treatment naive patient, antiresorptive should be avoided. Reason? Healthy bones can’t be formed or even maintained with minimal activities of osteoclasts. When a person has very low CTX to start with and you suppress it further with an antiresorptive, the old and damaged bone brought on by daily wear and tear won’t be absorbed or cleared away by osteoclasts. Therefore any new bones built on this shaky foundation won’t be of good quality. This is part of the reason we see chances of ONJ and AFF go up after long term antiresorptive therapy, especially a potent one. The analogy here is how a rotten/damaged wood or a water damaged dry wall is repaired. We would not just slap a coat of new paint onto them and call it a day, even with a small damage.
The second part of your question is more complicated to answer. My short answer is yes, the drug that one chooses determines the frequency of testing, especially if data from a named RCT is available for referencing. I’d think it’s prudent to do more frequent testings under several scenarios: 1) when there aren’t any good referencing data one could use, but patient/endo wants an early “peek”to the therapy before annual/biannual dexa; 2) the endo/patient is doing some unusual treatment plan such as variation in dosing, variation in recommended length of treatment, or unknown/untested combination or sequencing; 3) the period during stoppage of prolia and its transition to next drug until stabilizing. Surely there are other scenarios when we’d want more testings, hope other members chime in.
This is great info. But what about low CTX after treatment with Forteo, Tymlos or Evenity? It seems reasonable to wait until CTX rises. My main doc doesn't do markers and my other endo who does test, says don't wait. I personally think it makes sense to wait until CTX goes up. No info no how high, or what happens once on Reclast in terms of over-suppression.
This is great info. But what about low CTX after treatment with Forteo, Tymlos or Evenity? It seems reasonable to wait until CTX rises. My main doc doesn't do markers and my other endo who does test, says don't wait. I personally think it makes sense to wait until CTX goes up. No info no how high, or what happens once on Reclast in terms of over-suppression.
dna41,
normal stretches from 104 to 1008. Your number though (if you are still on Prolia) drops after the shot (by as much as 80% initially) and gradually rises until your next injection.
You may know that Prolia works by repressing the cells that break down the bone. CTX is a measurement of that process. P1NP reflects bone that is building. It will also be lowered by Prolia injections. Prolia doesn't build bone but collects old bone thereby increasing BMD. The repressed cells that breakdown bone collect as a resevoir of precurser cells that are released when you are late for or stop taking the injections.
That is why it is so dangerous to stop the drug without following with a drug that will give you protection from those resevoir cells.
Do you have a baseline CTX. Do you have P1NP numbers? How far inbetween injctions are you. Were you able to find a provider with a license to prescribe Prolia?
I have actually been on Prolia several years. I am currently getting ready for Reclast, thus the bone markers. I am trying to get clarification on these tests since they are listed in a different format in my tests results.
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Great questions @gently.
My CTX is low. One doc says studies show no difference in outcome when going on Reclast with low CTX after Evenity. McCormick says to test and wait. Other doc doesn't test at all but waits 3 months between Evenity and Reclast for mineralization to complete.
Over suppression of turnover is a concern expressed by McCormick, yet this is how anti-resorptives work. I plan on asking my doc about this.
Look forward to any info here. We need more research and consensus!
@gently, I’ll try to answer your question with the knowledge I gathered so far.
The short answer is: with a very low CTX baseline for a treatment naive patient, antiresorptive should be avoided. Reason? Healthy bones can’t be formed or even maintained with minimal activities of osteoclasts. When a person has very low CTX to start with and you suppress it further with an antiresorptive, the old and damaged bone brought on by daily wear and tear won’t be absorbed or cleared away by osteoclasts. Therefore any new bones built on this shaky foundation won’t be of good quality. This is part of the reason we see chances of ONJ and AFF go up after long term antiresorptive therapy, especially a potent one. The analogy here is how a rotten/damaged wood or a water damaged dry wall is repaired. We would not just slap a coat of new paint onto them and call it a day, even with a small damage.
The second part of your question is more complicated to answer. My short answer is yes, the drug that one chooses determines the frequency of testing, especially if data from a named RCT is available for referencing. I’d think it’s prudent to do more frequent testings under several scenarios: 1) when there aren’t any good referencing data one could use, but patient/endo wants an early “peek”to the therapy before annual/biannual dexa; 2) the endo/patient is doing some unusual treatment plan such as variation in dosing, variation in recommended length of treatment, or unknown/untested combination or sequencing; 3) the period during stoppage of prolia and its transition to next drug until stabilizing. Surely there are other scenarios when we’d want more testings, hope other members chime in.
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2 ReactionsThis is great info. But what about low CTX after treatment with Forteo, Tymlos or Evenity? It seems reasonable to wait until CTX rises. My main doc doesn't do markers and my other endo who does test, says don't wait. I personally think it makes sense to wait until CTX goes up. No info no how high, or what happens once on Reclast in terms of over-suppression.
I would like to know what is considered low CTX. Mine is 300. Is that low?
Deleted due to mistake in post!
Windy, your CTX is now in the 30s? Your last one is around 180 if I remember correctly.
@dna41 is this your baseline CTX? Do you happen to have P1NP tested at the same time also?
I made a mistake. I believe it is 74. I am trying to get clarification on both CTX and P1NP.
dna41,
normal stretches from 104 to 1008. Your number though (if you are still on Prolia) drops after the shot (by as much as 80% initially) and gradually rises until your next injection.
You may know that Prolia works by repressing the cells that break down the bone. CTX is a measurement of that process. P1NP reflects bone that is building. It will also be lowered by Prolia injections. Prolia doesn't build bone but collects old bone thereby increasing BMD. The repressed cells that breakdown bone collect as a resevoir of precurser cells that are released when you are late for or stop taking the injections.
That is why it is so dangerous to stop the drug without following with a drug that will give you protection from those resevoir cells.
Do you have a baseline CTX. Do you have P1NP numbers? How far inbetween injctions are you. Were you able to find a provider with a license to prescribe Prolia?
I have actually been on Prolia several years. I am currently getting ready for Reclast, thus the bone markers. I am trying to get clarification on these tests since they are listed in a different format in my tests results.