sebutler, will you take a month away before starting Tymlos.
The endocrinologist I see agreed that I could take a third year of Forteo, but wouldn't agree to my switching to Tymlos for that third year. We're in uncharted territory.
It makes sense to me because Forteo is thought to reach a peak where osteoclasts are acidifying more bone than osteoblasts can build, as evidenced by CTX/P1NP ratio. Tymlos was developed to stimulate fewer osteoclasts.
Since both medications are adept at restructuring bones, their effect is most significant in structural integrity rather than density. In a final steps the osteocytes form cannulations in the bone making it more sensitive to changes needed in regard to our activities. This cannulation may be responsible for a falsely determined work stoppage as the bone might become lighter and more flexible as reflected in the TBS score which translates into lower fracture (FRAX) risk.
I like your endocrinologist. And am excited for our results in this following year. Are you having bone markers?
Hi, @gently -- we meet once again! Thank you for this info. I believe the same thing happens with Tymlos -- after 1.5 years, its effectiveness wanes (the Tymlos company chart has a chart). And I suspect that the osteoclasts start taking over, because Tymlos also increases their activity. I'm not sure I understand what you are saying about cannulation -- so cannulation is good? decreases fracture risk? I would think it would increase the fracture risk. Once I finish with Tymlos in December, my endocrinologist said she would start doing the bone markers. (My rheumatologist has been doing the markers meanwhile.). I'm assuming that would be used to monitor what the osteoclasts/osteoblasts are up to. Is there a ratio between the two that is good? I think I read someplace that the ratio should be something like 10 to 1 -- that is CTX 10 times more than P1NP.
SE, happy to hear from you.
I gave the chart a second look wanting to expand the use of the medication. Only looking at CTX/P1NP ratios (which do correspond with bone acquisition after 12 months) may be short sighted, if osteoblasts live a few weeks or months and osteocytes live for decades.
There may be a cycle (beyond the daily/nightly) where the balance of CTX/P1NP needs to be imbalanced for more effective bone growth.
I worry (a little)because personally I have noticed that three weeks of not taking the medication drops the CTX in greater percentage than P1NP. In taking advantage of that shift in balance, I might be disrupting a larger uncharted process, rather than my hope of expanding the anabolic window.
I'm searching for references regarding the 10 to 1. Without positing any hypothesis, I like my osteoblast number close to the osteoclast number, valuing those much maligned osteoclasts.
I'd love to see your bone marker numbers. Good for getting them from the Rheumatologist.
You may not care enough about the canaliculus, but here is Ebreheim.
I must have read a speculation about the lowering of bone density in the hip with the anabolics. Then it made personal sense to me that porosity can increase flexibility and lessen fracture risk.
Have you decided on an antiresorptive.
Hi, @gently -- we meet once again! Thank you for this info. I believe the same thing happens with Tymlos -- after 1.5 years, its effectiveness wanes (the Tymlos company chart has a chart). And I suspect that the osteoclasts start taking over, because Tymlos also increases their activity. I'm not sure I understand what you are saying about cannulation -- so cannulation is good? decreases fracture risk? I would think it would increase the fracture risk. Once I finish with Tymlos in December, my endocrinologist said she would start doing the bone markers. (My rheumatologist has been doing the markers meanwhile.). I'm assuming that would be used to monitor what the osteoclasts/osteoblasts are up to. Is there a ratio between the two that is good? I think I read someplace that the ratio should be something like 10 to 1 -- that is CTX 10 times more than P1NP.
Could you please tell me the purpose of getting a bone marker test? Is it used to determine whether a particular drug is doing any good so if need be you can switch to another drug mid-stream (so to speak)? I have been on Tymlos nearly two years; good gains the first, but I just had a dexa and results were disappointing for this 2nd year, no progress in the hip, minimal gains in the spine. So I'm wondering whether it would be beneficial once I start a new drug to have bone marker tests at some point rather than just following a doc's prescribed course of the drug.
Could you please tell me the purpose of getting a bone marker test? Is it used to determine whether a particular drug is doing any good so if need be you can switch to another drug mid-stream (so to speak)? I have been on Tymlos nearly two years; good gains the first, but I just had a dexa and results were disappointing for this 2nd year, no progress in the hip, minimal gains in the spine. So I'm wondering whether it would be beneficial once I start a new drug to have bone marker tests at some point rather than just following a doc's prescribed course of the drug.
I'm in the same boat...disappointing results and never any mention of bone markers by rheum or endo - just saw mentions of it on this forum. Neither advises more time on tymlos or starting forteo- they only suggest a bisphosphenate or Prolia (no way on the latter!)
Frankly no one I consult really gives helpful guidance - they just list all the available treatment options and say it's up to me. I can get THAT from Dr. Google.
Leaning towards a 1x week bisphosphate for a couple of years.
Hi, @bayhorse. Four months after starting Tymlos, my rheumatologist had me test for P1NP, a marker for bone formation (osteoblast activity) to see if Tymlos was doing its job. It was -- my P1NP went from 59 (taken when I first met her) to 183. My DEXA a year later reflected that: improvement in my spine and hip. I'm now starting my second year of Tymlos, and my endocrinologist warned me that while the first year showed significant improvement, any improvement in my second year will be much smaller. (A chart on the Tymlos website shows that increases in BMD starts dropping the second year.) So it looks like you shouldn't be surprised about your second-year results.
My endocrinologist said she would use the markers, specifically the CTX, once I start a bisphosphonate, to make sure my bone resorption level is going back down to "normal" (Tymlos increases it, just as it increases bone formation). At least that is what I think she said. (I'm hoping others on this thread will weigh in on what they have learned.).
Both my rheumatologist and my endocrinologist are insistent I take one of the bisphosphonates after finishing Tymlos to preserve the new bone formed. My rheumatologist said that one of her patients didn't want to take a bisphosphonate afterward, and ended up losing all the new bone that had been created. (Which, if she was paying what I have had to pay for this drug, was a huge waste of money!)
Could you please tell me the purpose of getting a bone marker test? Is it used to determine whether a particular drug is doing any good so if need be you can switch to another drug mid-stream (so to speak)? I have been on Tymlos nearly two years; good gains the first, but I just had a dexa and results were disappointing for this 2nd year, no progress in the hip, minimal gains in the spine. So I'm wondering whether it would be beneficial once I start a new drug to have bone marker tests at some point rather than just following a doc's prescribed course of the drug.
bayhorse, bone markers are generally used after the first couple of months of a new osteoporosis medication to determine if a medication is working in your body. While there is usually a large sometimes 100% rise in P1NP after two months of an anabolic, the change at one month with bisphosphonates is usually a 30 to 50% drop in CTX.
A lack of change might initiate an effort to determine a secondary cause of osteoporosis or the need for a different medication.
CTX with Prolia decreases rapidly usually to below baseline in the first month of use. Decrease in P1NP is slower, but also significant.
Many endocrinologist don't use bone markers.
There is speculation that there might be an ideal relationship between CTX and P1NP. I speculate myself, but the closest I've read is that there needs to be a balance.
Hi, @bayhorse. Four months after starting Tymlos, my rheumatologist had me test for P1NP, a marker for bone formation (osteoblast activity) to see if Tymlos was doing its job. It was -- my P1NP went from 59 (taken when I first met her) to 183. My DEXA a year later reflected that: improvement in my spine and hip. I'm now starting my second year of Tymlos, and my endocrinologist warned me that while the first year showed significant improvement, any improvement in my second year will be much smaller. (A chart on the Tymlos website shows that increases in BMD starts dropping the second year.) So it looks like you shouldn't be surprised about your second-year results.
My endocrinologist said she would use the markers, specifically the CTX, once I start a bisphosphonate, to make sure my bone resorption level is going back down to "normal" (Tymlos increases it, just as it increases bone formation). At least that is what I think she said. (I'm hoping others on this thread will weigh in on what they have learned.).
Both my rheumatologist and my endocrinologist are insistent I take one of the bisphosphonates after finishing Tymlos to preserve the new bone formed. My rheumatologist said that one of her patients didn't want to take a bisphosphonate afterward, and ended up losing all the new bone that had been created. (Which, if she was paying what I have had to pay for this drug, was a huge waste of money!)
You are very lucky to have such a conscientious doc. I have an endo and a rheumatologist, and neither has ever mentioned bone markers or suggested checking how well a drug was working after I started it. They rely simply on DEXA results... useless if you've just about finished a time-limited course of medication. Glad to know about this and will be checking in the future!
BTW, my endo is pushing me to use Prolia after the Tymlos. When I questioned her about increased fracture risk if Prolia is discontinued, she said yes, absolutely, but I'd start a bisphosphinate (likely Reclast) if I had to stop the Prolia. Is your doc suggesting a bisphosphinate after Tymlos primarily because you don't want to take Prolia?
bayhorse, bone markers are generally used after the first couple of months of a new osteoporosis medication to determine if a medication is working in your body. While there is usually a large sometimes 100% rise in P1NP after two months of an anabolic, the change at one month with bisphosphonates is usually a 30 to 50% drop in CTX.
A lack of change might initiate an effort to determine a secondary cause of osteoporosis or the need for a different medication.
CTX with Prolia decreases rapidly usually to below baseline in the first month of use. Decrease in P1NP is slower, but also significant.
Many endocrinologist don't use bone markers.
There is speculation that there might be an ideal relationship between CTX and P1NP. I speculate myself, but the closest I've read is that there needs to be a balance.
Hi, gently, and thanks for your reply. I have to admit, though, it is over my head. I am going to have to do more reading on P1NP & CTX in order to understand what you're trying to tell me! 🙂
SE, happy to hear from you.
I gave the chart a second look wanting to expand the use of the medication. Only looking at CTX/P1NP ratios (which do correspond with bone acquisition after 12 months) may be short sighted, if osteoblasts live a few weeks or months and osteocytes live for decades.
There may be a cycle (beyond the daily/nightly) where the balance of CTX/P1NP needs to be imbalanced for more effective bone growth.
I worry (a little)because personally I have noticed that three weeks of not taking the medication drops the CTX in greater percentage than P1NP. In taking advantage of that shift in balance, I might be disrupting a larger uncharted process, rather than my hope of expanding the anabolic window.
I'm searching for references regarding the 10 to 1. Without positing any hypothesis, I like my osteoblast number close to the osteoclast number, valuing those much maligned osteoclasts.
I'd love to see your bone marker numbers. Good for getting them from the Rheumatologist.
You may not care enough about the canaliculus, but here is Ebreheim.
I must have read a speculation about the lowering of bone density in the hip with the anabolics. Then it made personal sense to me that porosity can increase flexibility and lessen fracture risk.
Have you decided on an antiresorptive.
@gently, Do you stop taking Forteo for 3 weeks so that you lower the number of osteoclasts in comparison to osteoblasts? I wonder if I should skip some days, because my CTX has always been very high (1400) on both Forteo and a half dose of Tymlos. Do you feel better during those 3 weeks off? I skipped one day of Forteo and did feel better.
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sebutler, will you take a month away before starting Tymlos.
The endocrinologist I see agreed that I could take a third year of Forteo, but wouldn't agree to my switching to Tymlos for that third year. We're in uncharted territory.
It makes sense to me because Forteo is thought to reach a peak where osteoclasts are acidifying more bone than osteoblasts can build, as evidenced by CTX/P1NP ratio. Tymlos was developed to stimulate fewer osteoclasts.
Since both medications are adept at restructuring bones, their effect is most significant in structural integrity rather than density. In a final steps the osteocytes form cannulations in the bone making it more sensitive to changes needed in regard to our activities. This cannulation may be responsible for a falsely determined work stoppage as the bone might become lighter and more flexible as reflected in the TBS score which translates into lower fracture (FRAX) risk.
I like your endocrinologist. And am excited for our results in this following year. Are you having bone markers?
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Like -
Helpful -
Hug
2 ReactionsHi, @gently -- we meet once again! Thank you for this info. I believe the same thing happens with Tymlos -- after 1.5 years, its effectiveness wanes (the Tymlos company chart has a chart). And I suspect that the osteoclasts start taking over, because Tymlos also increases their activity. I'm not sure I understand what you are saying about cannulation -- so cannulation is good? decreases fracture risk? I would think it would increase the fracture risk. Once I finish with Tymlos in December, my endocrinologist said she would start doing the bone markers. (My rheumatologist has been doing the markers meanwhile.). I'm assuming that would be used to monitor what the osteoclasts/osteoblasts are up to. Is there a ratio between the two that is good? I think I read someplace that the ratio should be something like 10 to 1 -- that is CTX 10 times more than P1NP.
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Like -
Helpful -
Hug
1 ReactionSE, happy to hear from you.
I gave the chart a second look wanting to expand the use of the medication. Only looking at CTX/P1NP ratios (which do correspond with bone acquisition after 12 months) may be short sighted, if osteoblasts live a few weeks or months and osteocytes live for decades.
There may be a cycle (beyond the daily/nightly) where the balance of CTX/P1NP needs to be imbalanced for more effective bone growth.
I worry (a little)because personally I have noticed that three weeks of not taking the medication drops the CTX in greater percentage than P1NP. In taking advantage of that shift in balance, I might be disrupting a larger uncharted process, rather than my hope of expanding the anabolic window.
I'm searching for references regarding the 10 to 1. Without positing any hypothesis, I like my osteoblast number close to the osteoclast number, valuing those much maligned osteoclasts.
I'd love to see your bone marker numbers. Good for getting them from the Rheumatologist.
You may not care enough about the canaliculus, but here is Ebreheim.
I must have read a speculation about the lowering of bone density in the hip with the anabolics. Then it made personal sense to me that porosity can increase flexibility and lessen fracture risk.
Have you decided on an antiresorptive.
-
Like -
Helpful -
Hug
2 ReactionsCould you please tell me the purpose of getting a bone marker test? Is it used to determine whether a particular drug is doing any good so if need be you can switch to another drug mid-stream (so to speak)? I have been on Tymlos nearly two years; good gains the first, but I just had a dexa and results were disappointing for this 2nd year, no progress in the hip, minimal gains in the spine. So I'm wondering whether it would be beneficial once I start a new drug to have bone marker tests at some point rather than just following a doc's prescribed course of the drug.
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Like -
Helpful -
Hug
1 ReactionI'm in the same boat...disappointing results and never any mention of bone markers by rheum or endo - just saw mentions of it on this forum. Neither advises more time on tymlos or starting forteo- they only suggest a bisphosphenate or Prolia (no way on the latter!)
Frankly no one I consult really gives helpful guidance - they just list all the available treatment options and say it's up to me. I can get THAT from Dr. Google.
Leaning towards a 1x week bisphosphate for a couple of years.
-
Like -
Helpful -
Hug
2 ReactionsHi, @bayhorse. Four months after starting Tymlos, my rheumatologist had me test for P1NP, a marker for bone formation (osteoblast activity) to see if Tymlos was doing its job. It was -- my P1NP went from 59 (taken when I first met her) to 183. My DEXA a year later reflected that: improvement in my spine and hip. I'm now starting my second year of Tymlos, and my endocrinologist warned me that while the first year showed significant improvement, any improvement in my second year will be much smaller. (A chart on the Tymlos website shows that increases in BMD starts dropping the second year.) So it looks like you shouldn't be surprised about your second-year results.
My endocrinologist said she would use the markers, specifically the CTX, once I start a bisphosphonate, to make sure my bone resorption level is going back down to "normal" (Tymlos increases it, just as it increases bone formation). At least that is what I think she said. (I'm hoping others on this thread will weigh in on what they have learned.).
Both my rheumatologist and my endocrinologist are insistent I take one of the bisphosphonates after finishing Tymlos to preserve the new bone formed. My rheumatologist said that one of her patients didn't want to take a bisphosphonate afterward, and ended up losing all the new bone that had been created. (Which, if she was paying what I have had to pay for this drug, was a huge waste of money!)
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Like -
Helpful -
Hug
3 Reactionsbayhorse, bone markers are generally used after the first couple of months of a new osteoporosis medication to determine if a medication is working in your body. While there is usually a large sometimes 100% rise in P1NP after two months of an anabolic, the change at one month with bisphosphonates is usually a 30 to 50% drop in CTX.
A lack of change might initiate an effort to determine a secondary cause of osteoporosis or the need for a different medication.
CTX with Prolia decreases rapidly usually to below baseline in the first month of use. Decrease in P1NP is slower, but also significant.
Many endocrinologist don't use bone markers.
There is speculation that there might be an ideal relationship between CTX and P1NP. I speculate myself, but the closest I've read is that there needs to be a balance.
You are very lucky to have such a conscientious doc. I have an endo and a rheumatologist, and neither has ever mentioned bone markers or suggested checking how well a drug was working after I started it. They rely simply on DEXA results... useless if you've just about finished a time-limited course of medication. Glad to know about this and will be checking in the future!
BTW, my endo is pushing me to use Prolia after the Tymlos. When I questioned her about increased fracture risk if Prolia is discontinued, she said yes, absolutely, but I'd start a bisphosphinate (likely Reclast) if I had to stop the Prolia. Is your doc suggesting a bisphosphinate after Tymlos primarily because you don't want to take Prolia?
-
Like -
Helpful -
Hug
1 ReactionHi, gently, and thanks for your reply. I have to admit, though, it is over my head. I am going to have to do more reading on P1NP & CTX in order to understand what you're trying to tell me! 🙂
@gently, Do you stop taking Forteo for 3 weeks so that you lower the number of osteoclasts in comparison to osteoblasts? I wonder if I should skip some days, because my CTX has always been very high (1400) on both Forteo and a half dose of Tymlos. Do you feel better during those 3 weeks off? I skipped one day of Forteo and did feel better.