1. < Osteoporosis & Bone Health
Profile picture for leslie559

CTX and P1NP before 2nd shot

Posted by leslie559 @leslie559, Jun 2 3:56pm

I had my CTX and P1NP markers done as I’m coming up on my 2nd shot in a couple of days now. My concern in my CTX is 64 and my P1NP is less than 10. I’m thinking that it is too low and I’ll end up with bigger issues since getting my injection will cause further suppression of my already low BTM’s. Any thoughts? Trying to figure this out. I’ve only had one injection, so far.
Thank you for any insight you may have

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

Profile picture for mayblin
mayblin | @mayblin | Jun 3 9:22am
In reply to @leslie559 "@mayblin yes" + (show)

@leslie559 there was a BTM substudy during denosumab phase 3 trial (Freedom) which showed before the second injection, 79% of study subjects still had CTX below the premenopausal reference range - yours is showing just that. This level of suppression is expected and confirms the med is working as intended. That said, the trough CTX does tend to creep up slightly with each successive injection cycle which is well documented. Hope this helps, and you stay on your injection as scheduled.

REPLY
Profile picture for pdl57
pdl57 | @pdl57 | Jun 3 11:11am

Hi, I had 18 shots of Prolia, fro which I am relaying off mid July with Zolandronic Acid infusion.

I remember the GP testing me for the usual panels just before the second shot, and he added P1NP ( unfortunately the labels for CTX in the UK can not be precribed but the hospital).

However I remember perfectly well that it was suppressed down to 11, even if it was 4 weeks before the next injection.
I was then tested on 2 more occasions under Prolia and it was always suppressed to below the lowest normal range staying at around 11, even 7 !!! once.
The peculiarity of this drug is that it suppresses both bone resorbsion and new bone formation.
It is the only drug to have this effect on bone metabolism.
For this reason, although I will be monitored every 3 months with CTX and P1NP + on 3 monthly review protocol on regular basis for while for stopping the med, I am still very worried about out the rebound ang rhe risk of spontaneuos V. fractures.
I am expecting CTX to accelerate quickly above 350, while P1NP will be on a slower recovery.
Overall my gains were not great, I think.
Currently -2.3 lumber , -2.5 FN. Should have not been on it of this long, but unfortunately the rheumo wanted me to stay for life, and I don't want to be on it in my laten70s.
My health has suffered too much under this drug, so no more. Another pneumonia or another cellulites or another tooth exrraxtion jnder this medication is a problem for me since my immune system has weakend, and I have become more antibiotic resistant it seems.
I am 68, started in Prolia in 2014 at 56, with 3 yrs of ZA infusions in 2016, only to be put back on Prolia again end of 2018 which I regret.

REPLY
2 replies
Profile picture for kfhoz
kfhoz | @kfhoz | Jun 3 12:11pm
In reply to @pdl57 "Hi, I had 18 shots of Prolia, fro which I am relaying off mid July with..." + (show)
Profile picture for pdl57 @pdl57

Hi, I had 18 shots of Prolia, fro which I am relaying off mid July with Zolandronic Acid infusion.

I remember the GP testing me for the usual panels just before the second shot, and he added P1NP ( unfortunately the labels for CTX in the UK can not be precribed but the hospital).

However I remember perfectly well that it was suppressed down to 11, even if it was 4 weeks before the next injection.
I was then tested on 2 more occasions under Prolia and it was always suppressed to below the lowest normal range staying at around 11, even 7 !!! once.
The peculiarity of this drug is that it suppresses both bone resorbsion and new bone formation.
It is the only drug to have this effect on bone metabolism.
For this reason, although I will be monitored every 3 months with CTX and P1NP + on 3 monthly review protocol on regular basis for while for stopping the med, I am still very worried about out the rebound ang rhe risk of spontaneuos V. fractures.
I am expecting CTX to accelerate quickly above 350, while P1NP will be on a slower recovery.
Overall my gains were not great, I think.
Currently -2.3 lumber , -2.5 FN. Should have not been on it of this long, but unfortunately the rheumo wanted me to stay for life, and I don't want to be on it in my laten70s.
My health has suffered too much under this drug, so no more. Another pneumonia or another cellulites or another tooth exrraxtion jnder this medication is a problem for me since my immune system has weakend, and I have become more antibiotic resistant it seems.
I am 68, started in Prolia in 2014 at 56, with 3 yrs of ZA infusions in 2016, only to be put back on Prolia again end of 2018 which I regret.

Jump to this post

@pdl57 All pure anti-resorption treatments, which denosumab (brand name Prolia) is one of, lower bone turnover markers. Even though the direct action that they take is to reduce bone breakdown, that causes bone-building to slow. Bone building is triggered, at least in part, by the osteoclasts finishing their job. So anything that only lowers bone breakdown has the unwanted effect of also lowering bone building. *

Reference: Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis
https://www.nejm.org/doi/full/10.1056/NEJMoa0809493
EXCERPT: "Denosumab ... blocks ... the development and activity of osteoclasts, decreasing bone resorption ... "

* Note that romosozumab (brand name Evenity) is the only OP drug that has both an anabolic bone-building action and it also inhibits bone breakdown. HRT is a less clear to me, but I believe it primarily reduces break-down but can sometimes stimulate bone building.

Romosozumab
https://www.ncbi.nlm.nih.gov/books/NBK585139/
EXCERPT: "Romosozumab ... This anabolic medication stimulates bone formation while suppressing bone resorption. "

REPLY
1 reply
Profile picture for leslie559
leslie559 | @leslie559 | Jun 3 1:10pm
In reply to @kfhoz "@pdl57 All pure anti-resorption treatments, which denosumab (brand name Prolia) is one of, lower bone turnover..." + (show)
Profile picture for kfhoz @kfhoz

@pdl57 All pure anti-resorption treatments, which denosumab (brand name Prolia) is one of, lower bone turnover markers. Even though the direct action that they take is to reduce bone breakdown, that causes bone-building to slow. Bone building is triggered, at least in part, by the osteoclasts finishing their job. So anything that only lowers bone breakdown has the unwanted effect of also lowering bone building. *

Reference: Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis
https://www.nejm.org/doi/full/10.1056/NEJMoa0809493
EXCERPT: "Denosumab ... blocks ... the development and activity of osteoclasts, decreasing bone resorption ... "

* Note that romosozumab (brand name Evenity) is the only OP drug that has both an anabolic bone-building action and it also inhibits bone breakdown. HRT is a less clear to me, but I believe it primarily reduces break-down but can sometimes stimulate bone building.

Romosozumab
https://www.ncbi.nlm.nih.gov/books/NBK585139/
EXCERPT: "Romosozumab ... This anabolic medication stimulates bone formation while suppressing bone resorption. "

Jump to this post

@kfhoz interestingly, when I was tested 3 months after starting Evenity, which is when it is in it’s anabolic phase, my P1NP dropped from 39 to 17. I would have understood if it was later in the 12 month cycle but we were just in the beginning portion.
As far as Prolia goes….I thought the ‘rule’ was they still wanted it to be about 100 before the next injection. I guess I will find out tomorrow before I get my 2nd injection.

REPLY
Profile picture for leslie559
leslie559 | @leslie559 | Jun 3 1:12pm
In reply to @pdl57 "Hi, I had 18 shots of Prolia, fro which I am relaying off mid July with..." + (show)
Profile picture for pdl57 @pdl57

Hi, I had 18 shots of Prolia, fro which I am relaying off mid July with Zolandronic Acid infusion.

I remember the GP testing me for the usual panels just before the second shot, and he added P1NP ( unfortunately the labels for CTX in the UK can not be precribed but the hospital).

However I remember perfectly well that it was suppressed down to 11, even if it was 4 weeks before the next injection.
I was then tested on 2 more occasions under Prolia and it was always suppressed to below the lowest normal range staying at around 11, even 7 !!! once.
The peculiarity of this drug is that it suppresses both bone resorbsion and new bone formation.
It is the only drug to have this effect on bone metabolism.
For this reason, although I will be monitored every 3 months with CTX and P1NP + on 3 monthly review protocol on regular basis for while for stopping the med, I am still very worried about out the rebound ang rhe risk of spontaneuos V. fractures.
I am expecting CTX to accelerate quickly above 350, while P1NP will be on a slower recovery.
Overall my gains were not great, I think.
Currently -2.3 lumber , -2.5 FN. Should have not been on it of this long, but unfortunately the rheumo wanted me to stay for life, and I don't want to be on it in my laten70s.
My health has suffered too much under this drug, so no more. Another pneumonia or another cellulites or another tooth exrraxtion jnder this medication is a problem for me since my immune system has weakend, and I have become more antibiotic resistant it seems.
I am 68, started in Prolia in 2014 at 56, with 3 yrs of ZA infusions in 2016, only to be put back on Prolia again end of 2018 which I regret.

Jump to this post

@pdl57 I sure hope you are still going to follow up with your ZA infusions to avoid the rebound of Prolia, especially after so many injections. I feel like it’s a never ending sad song. I hope things get better for you.

REPLY
Please sign in or register to post a reply.