Bone turnover markers (CTX and P1NP): do you have a baseline?

For what it may be worth, up to you to put a value on. this is what McCormick "likes" to see. Go to page 4.

I have not started any medication treatment so these would be my baseline values.
PINP = 50
CTX = 210 (morning with a soft fast)

@normahorn thank you very much for your reply! Thank you very mucn for the link also. Ive read it and i also have a copy of "great bones". May I ask a few more questions:

*Did you have any bone meds (including estrogen, Evista, bisphosphonates, prolia, or any of the 3 anabolics in the past, or in the distant past (5-10 years ago)?
*What time in the morning did you have your blood drawn, and whats your daily average waking hours?
*Soft fast- does it mean that you had some food prior to test? This might alter ctx results a bit.
*Couple days prior to your tests, did you take collagen or biotin supplements?
*Do you happen to have secondary cause for osteoporosis that you know of?

If information gets too personal, feel free not to disclose here, i understand. Or if you feel appropriate, feel free to pm me, but make sure that you exclude sensitive personal information such as location, name, date of birth or anything that should be kept private.

I have a CTX distribution graph for post menapausal women, but am intrigued how to look at ctx and p1np together. Thanks a lot!

Mayblin, what a great idea.
I was just reading that taking collagen type 1 increases P1NP
I have to go and find my bone marker numbers.

I am a 59 year old male, so take these numbers with a grain of salt. See photo attached.

I was not told to fast so had my normal cup of coffee, with sugar, before the blood draw. That was at 9:30 AM. I am not a breakfast eater.

At the time, I had started taking a Calcium supplement, possibly with Vit D3. I refuse to be a pill junkie so currently limit my intake to 5 pills, not servings (that includes presciption medication) a day and they are all taken at the same time

Hi @michaellavacot, thank you very much for your reply and sharing your treatment information. To me, your baseline btms showed a very high resorption rate, while p1np is alright. Do you have a known secondary cause for the high resorption rate, may I ask?

Although you had one set of btms during evenity treatment, the changes in both p1np and ctx fell in expection when compared to what manufacturer stated. Did you have a good gain in dexa after 1 year evenity?

Looks like you and your doctor decided on prolia to follow evenity, as Amgen suggested.

Thanks again!

Hi @normahorn thank you very much for clarifying. Your baseline is interesting because neither ctx or p1np shows anything unusual. Your ctx is pretty low compared to most postmenopausal women, or we can say your ctx falls within the lower half of a young woman's value. Interesting. Do you have osteoporosis or osteopenia? What did your doctor say about your situation?

I recall you actually have a thread about CLL, I'm so sorry to hear that and wish it stays where it is. At the same time, I wonder if it causes your bone problem, if any?

Wish you all the best!

I have osteoporosis according to my one and only DEXA. I am fine-boned so my condition may be overestimated and no effort was made to position me,

I do not think my cll added to the situation but might come into play when it comes to treatment.

Interesting drop in P1NP after initiation of Prolia. Supports that suspicion that if Evenity becomes antiresorptive for a longer period than it is anabolic, Prolia might not be the best follow-up medication.

I see. Hopefully your doc figures out whether or not there is a secondary cause and finds a best solution going forward!

Having food before blood drawing for bone marker testing is known to affect results, especially with CTX. According to one published paper, "Feeding/fasting state has an impact on BTMs. Morning feeding decreased PINP (3.8%), OC (4.1%), uNTX (7.9%), and CTX (17.8%) while bone ALP did not vary significantly". Your cup of coffee with sugar may or maynot cause too much change in CTX. With regards to time of testing, "CTX showed the greatest diurnal fluctuation. Peak levels were observed between 0130 and 0430 hours and were 40% to 60% higher than the 24-hour mean, while the nadir was observed between 1100 and 1500 hours. The lowest value was 40% to 60% below the 24-hour mean". This is probably why Dr. McCormick recommends to get btms done within first hour of waking up, if possible.