DEXA, BTMs, accuracy and frequency

Posted by jozer @jozer, 18 hours ago

Not understanding osteoporosis testing. Exactly how often should or how often do most of you get the DEXA, (with TBS, if possible), BTMs (CTX, NTX, P1NP) and why. What do the numbers represent? Had a DEXA in '24, osteoporosis diagnosis from PCP, she sent me to an endo, put me on Fosamax (no CTX, etc), spring of '25 another DEXA, very slight improvement, I asked for CTX (after reading about BTMs online, also got NTX), which was at 52. Reclast infusion July '25. I mistakenly thought that a DEXA would be run yearly; I was told that I could possibly only need one Reclast infusion and in my brain, I thought a DEXA would show Reclast working or not. Now I am told that I can't have a DEXA for another year; the worry of wondering where I am at is over the top. The plan currently is to do another Reclast (he did run a CTX again; it is at 78). He said the BTMs (also ran NTX; normal levels) show that the drug is working so therefor we wouldn't need a DEXA. I have a referral for private pay but cannot get an accurate price from the DEXA I have gone to in the pas (quote from $1200 to $500, no TBS capability).

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gently | @gently | 17 hours ago

jozer,
Medicare pays for DEXA every year if my doctor writes a statement of Medical Necessity. Most osteoporosis patients have testing available every two years.
CTX and NTX measure resorption of bone. P1NP measures acquisition of new bone.
These tests should be done in the morning after full fasting for accuracy.
Without a baseline for CTX and even though CTX rose from 52 to 78 we assume with your doctor that Reclast is working.
Without your bone density numbers, it is tough to guess about continuing with Reclast. My suspicion is that you don't need another DEXA. They are less expensive at clinics than they are in hospitals. Their value in comparison is limited if you don't have the two on the same machine.
You might consider that for the many one year of Reclast is effective for two years.
Reclast works by slowing the breakdown and slowing the acquisition, which is why we usually don't have script for the serum acquisition number P1NP with any of the bisphosphonates. t
D3 is more readily absorbed than D2 and is generally considered a better choice.
Magnesium importantly limits the size and shape of hydroxyapatite crystals which gives bone strength and flexibility. You might add magnesium glycinate to your supplements because it also aids digestion.
Your situation is, of course, different from mine. But I would be anxious to take one of the anabolics instead of another year of Reclast. The two pth anabolics work the way our bones naturally replace fissured or weak bone with more speed. The mineral density gained on bisphosphonates is preserved bone, as it preserves that bone that would normally be replaced.
I have no medical background.