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

Hi @mayblin , Sure. After Evenity, my T-scores were at -3.9 for L2 in the spine (-3.0 total spine) and ~2.8 at the femoral neck. Using either alendronate or Reclast would not be able to get me into the osteopenia range, let alone into a safer range of -1.5 to -2.0. My plan is to stay on Prolia until I reach between -1.0 to -1.5 in both hip and spine and then switch to alendronate to transition away from Prolia. I will lose about a half a T-score when I do, but that will leave me in a comfortable range to switch to a maintenance mode of alternating alendronate and drug holiday. At least that's the plan.

Hi Michael,

It's great that you have a well thought out plan. Just want to alert you that, from what i have read (i can dig up reference links if you need), Alendronate will likely not be potent enough to offset the rebound effect once you have taken 4 or more Prolia shots. You will likely have to use Reclast as the relay drug instead

Hi @mayblin,

I really appreciate you looking out for me. Thanks for the note 🙂

You are likely right on alendronate not being effective enough to catch the rebound, but I'm going to try it and measure CTX monthly. If / when my CTX goes above my baseline, I will switch to Reclast. This is something Serge Ferrari suggested last year during a presentation he gave and there is a hypothesis as to why it might work. I talked about it in my Prolia presentation https://youtu.be/XiRN3UvOEYg?si=XbRjR9MaqN3UihrL . BTW, I watched a presentation last week from the 2024 World Congress of Osteoporosis and Professor Bente Langdahl (denosumab expert) said on average, they give three Reclast shots in the first year to blunt the rebound for long term Prolia users.

I really want to wait to use Reclast as my very last treatment at 80 years old. Reclast lasts a really long time on the bones so taking holiday's will probably not be as big of an advantage as being on alendronate. Dr. Mike McClung has proposed this strategy.

Michael, I think your comment were meant for @formisc.

I will comment after gathering my thoughts

Your right! Thanks and thanks @formisc 🙂

Hi @michaellavacot your choice of prolia after evenity was sure an interesting one at a time when most ppl think twice before starting it. I’m sure you are familiar with the mechanism of action of prolia as well as the mechanism of its rebound effect upon cessation.

In your special case, the hupercalciuria sounds the underlying cause of your op, the use of antiresorptive seems making most sense than an anabolic at the moment. I wonder if your blood calcium level, especially vital organs which need calcium to function get affected with an antiresorptive. Treatment and management of hypercalciuria definitely is a key here.

Hope you will use btms especially CTX to guide your therapy, especially during withdrawal of prolia when that time comes!

Hi @mayblin - I have done a lot of research on Prolia, a lot. I even put together a training on Prolia that I have presented to a BHOF support group. The recording of the session is here https://youtu.be/XiRN3UvOEYg?si=Cvi4LnK9uEejykPr .

Yeah, I'm convinced my hypercalciuria is my problem. You can't build bone if you are peeping out more calcium than your intestines can absorb. I'm working really hard on that problem. I'm even combing through my genome to find the issue. I have an upcoming appointment with the best nephrologist I could find next month.

Thanks for your support. I appreciate it. 🙂

I just received my first P1NP result. It is 81. I know little about these numbers. My last ctx was 300. I am waiting for the new result. Could someone help me with this?

Do you have CTX result (from same blood drawing as P1NP)?

I am waiting for the cycle from the blood draw. I never had the P1NP before… I actually requested it after reading about it on this site. I am on no drugs, except the testosterone, estradiol pellets and progesterone.