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Is Anyone Else Tracking Your P1NP to CTX Ratio, While Taking Tymlos?

Posted by CathyF31 @cathyf31, May 8 7:37am

It is believed that the threshold to indicate bone growth can be tracked by calculating your P1NP to CTX ratio. This sure seems logical, as the rate that you are building bone versus the rate that you're losing it are key factors. To calculate your P1NP : CTX ratio, simply take your CTX and divide it by 1000 (move the decimal 3 places to the left). Then, take your P1NP and divide it my your CTX÷1000 result. If greater than or equal to 150, your building of bone is out-pacing the breakdown/reabsorption (anabolic). So again, P1NP : CTX = P1NP ÷ (CTX/1000) Result: If >= 150, then anabolic.

Are you willing to share your past and/or current results and let us know how long you've been on Tymlos. Below are results that I just calculated. I will also try to repost the link to the video that explains the relationship between P1NP and CTX (interesting theories).

Here is some interesting trending for my bone building blood markers (from pre-treatment to breaks in treatment to now).....

Trending for Bone Formation Markers (P1NP : CTX Ratio >= 150 is ANABOLIC)
--------------------------
1) 08/28/25: Pre-Treatment
P1NP = 55
CTX = 492
Ratio = 112 (Losing) ❌️

2) 02/02/26: 1-Month Post-Stopping of Evenity #2 (1/2 dose)
P1NP = 52
CTX = 544
Ratio = 96 (Losing) ❌️

3) 05/04/26: Tymlos (3 wks @ full dose + 3 wks @ 1/2 to 3/4 dose)
P1NP = 128
CTX = 707
Ratio = 181 (Building) ✅️

Video - Scroll down in this linked post to find the video (hope this linking works): https://connect.mayoclinic.org/comment/1558097/

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

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jennirdh | @jennirdh | Jun 25 1:13pm
In reply to @cathyf31 "@jennirdh Have you had an annual DEXA bone scan to see the actual degree of improvement?..." + (show)
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@jennirdh Have you had an annual DEXA bone scan to see the actual degree of improvement?

I saw one story that said more and more doctors are considering Evenity, after Tymlos for one year, and then a final transition to Reclast. I trust it with depend on what your T-scores are now and how much more Improvement is needed to reduce your fracture risk and get you into osteopenia or better status...????

I've already failed the amenity treatment, due to side effects, so Reclast will be my final transition post-Tymlos.

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@cathyf31
My Dexa scores are not super accurate bc of the compression fractures I have had, they show up as more dense on Dexa, and since I’ve had a laminotomy of L 3&4 to decompress my spinal nerves bc of the stenosis caused by the compressed vertebrae it skews the Dexa results even more. So I mainly have to rely on the BTM numbers and the fact that I’ve had no new fractures in almost 2 years.
I’m sorry your Evenity experience did not go well. My sister has been on it for 11 months with no problems but she is very lucky that way.
Saw the doctor this morning, I will go the full 2 years on Tymlos (thru this September) and then do one infusion of Reclast, then recheck BTMS every 3 months or so.

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jennirdh | @jennirdh | Jun 25 1:18pm
In reply to @mayblin "@jennirdh, I'm sorry to hear about your rebound fractures after coming off prolia. Did your new..." + (show)
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@jennirdh, I'm sorry to hear about your rebound fractures after coming off prolia. Did your new doctor have any comments about Boniva as a follow-up after Prolia? Since you had discontinued Prolia, I imagine your endo likely recommend Reclast next as you mentioned, or Fosamax if you could tolerate it.

Please keep us updated on your progress and how things go after completing Tymlos. Wishing you the very best!

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@mayblin
The Doctor and I think that Boniva or fosamax is probably not strong enough for me since I was on them in the past but still fractured. Not excited about doing Reclast but I think it might be the best course. I plan to listen to all the ppl on this site that have told how they prepared themselves for the infusion and do the same. Thanks for the good wishes and same to you!

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gravity3 | @gravity3 | Jul 14 1:09pm
In reply to @jennirdh "Hi to the group! Here are my numbers after a horrific rebound effect from coming off..." + (show)
Profile picture for jennirdh @jennirdh

Hi to the group!
Here are my numbers after a horrific rebound effect from coming off 2 1/2 years of Prolia (even though I went on Boniva immediately) and my endocrinologist was not monitoring me closely at all, and I found out I was rebounding because I had 3 vertebral compression fractures within 3 months of each other. Now I am continuing to educate myself and have changed doctors to a person who really understands osteoporosis.
Oct 2024-
At start of Tymlos (with prior endo having no P1NP lab)
CTX 613
1/2025 CTX 713, P1NP 112
Ratio 157 ✅
3/2025 CTX 635, P1NP 112
Ratio 176 ✅
6/2026 CTX 543, P1NP 124
Ratio 228 ✅
11/2025 CTX 470, P1NP 94
Ratio 200 ✅
6/2026 CTX 252, P1NP 46
Ratio 182 ✅ (starting to come down now which would indicate effectiveness starting to wane).
I’m on my 20th month of Tymlos and 3/4 of the time done the full dose, the other times 5 clicks or higher. I think from these results I have had a good result from the anabolic, and when I see my doctor in a few days I’ll see what she thinks I’ll need to do when I’m finished to lock in my gains. Probably Reclast I’m guessing?
Any suggestions?

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jennirdh

I am so sorry that you e had to endure this. It appears that you are being monitored now. S

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