P1NP number on Tymlos

I will be starting Tymlos soon but my doctor has not ordered and P1NP or CTX as a baseline . Do you think I should request it ?

I will be starting Tymlos soon but my doctor has not ordered and P1NP or CTX as a baseline . Do you think I should request it ?

I have been on tymlos for 3 months with close to no side effects. I do my injection around 10pm right before bed. For the first month right after the injection I felt my heart rush just for about 3-5 minutes and sometimes still do. I also woke up with a dull nagging headache however that went away after about 1.5 months. So here is the current story:
My P1NP before the Tymlos was 42ug/L , after 3 months it’s 85ug/L
My CTX was 389 pg/ml, after 3 months on Tymlos it’s 485pg/ml.
At the same time I also started estradiol 1mg tablet and progesterone 100mg. I was very sensitive to the estradiol and had to reduce to half a tablet. As of yesterday I switched to the Dotti estradiol patch at 0.05 mg.
Because I started the BHRT and Tymlos at about the same time I was hoping my markers would have been better however I do see that the meds are working and my dr. and I have decided to continue this routine for at least another 10 months possibly more. My next appointment with the endocrinologist is Feb. 25, 2026 and I’ll have labs done again for that appointment. I’m scheduled for another dexa July 2026 and I sure hope I see an improvement! When I finally agreed to meds my dexa had increased in my spine by about 7%. My lumbar was -3.3 and both hips were -2.6 I had been trying to improve without meds however I was not consistent with weight/resistance exercises but I did walk at least 2 miles 5 times a week. I injured my elbow getting too exuberant with weights last spring and have not gotten back into a routine. I keep promising myself that I will start a slow weight/resistance exercise routine soon. I do still walk 2 - 4 miles 3 - 5 times a week. At this time dr. has not discussed what I will do once I complete 18-24 months of Tymlos. Maybe the BHRT is enough? I do not like what I read about reclast or fosamax however my dr. says it’s too soon to make a decision on that. He has indicated he would like meto stay on the Tymlos for the full 24 months but I’m resistant about that mostly because of the inconvenience of the daily injections and the fact that it must be refrigerated before use. It’s a pain to get the amount I need and keep it refrigerated when I travel. I usually leave the cold winters of MN for 4-6 months but since I can’t get the Tymlos filled for more than 90 days, which took me 1.5 months to get approved, I will not be able to escape the cold winter this season. I’m just lucky to currently have 3 pens to travel mid October - mid December. I also anticipate that it may be difficult this January to even get another prescription filled? I will have to search for different insurance since Ucare has discontinued their medicare advantage program. I’m hoping this will not be a problem once I get different insurance however it also took almost 2 months just to get the Tymlos approved since it was not on their formulary. Fingers crossed this will not be a problem come January on my new insurance, since I know I will need a new pen on January 9 2026 😨
I hope this information is helpful. I have gotten so much valuable information here and I hope to pass on my story to help others. It is early in my med journey but I wanted to give a shout out to those who are afraid of meds as I was and how important it is to gather information to help make a decision.

Oh yes thanks I meant to say keep the unused pens cold while traveling until their first use.

I have been on tymlos for 3 months with close to no side effects. I do my injection around 10pm right before bed. For the first month right after the injection I felt my heart rush just for about 3-5 minutes and sometimes still do. I also woke up with a dull nagging headache however that went away after about 1.5 months. So here is the current story:
My P1NP before the Tymlos was 42ug/L , after 3 months it’s 85ug/L
My CTX was 389 pg/ml, after 3 months on Tymlos it’s 485pg/ml.
At the same time I also started estradiol 1mg tablet and progesterone 100mg. I was very sensitive to the estradiol and had to reduce to half a tablet. As of yesterday I switched to the Dotti estradiol patch at 0.05 mg.
Because I started the BHRT and Tymlos at about the same time I was hoping my markers would have been better however I do see that the meds are working and my dr. and I have decided to continue this routine for at least another 10 months possibly more. My next appointment with the endocrinologist is Feb. 25, 2026 and I’ll have labs done again for that appointment. I’m scheduled for another dexa July 2026 and I sure hope I see an improvement! When I finally agreed to meds my dexa had increased in my spine by about 7%. My lumbar was -3.3 and both hips were -2.6 I had been trying to improve without meds however I was not consistent with weight/resistance exercises but I did walk at least 2 miles 5 times a week. I injured my elbow getting too exuberant with weights last spring and have not gotten back into a routine. I keep promising myself that I will start a slow weight/resistance exercise routine soon. I do still walk 2 - 4 miles 3 - 5 times a week. At this time dr. has not discussed what I will do once I complete 18-24 months of Tymlos. Maybe the BHRT is enough? I do not like what I read about reclast or fosamax however my dr. says it’s too soon to make a decision on that. He has indicated he would like meto stay on the Tymlos for the full 24 months but I’m resistant about that mostly because of the inconvenience of the daily injections and the fact that it must be refrigerated before use. It’s a pain to get the amount I need and keep it refrigerated when I travel. I usually leave the cold winters of MN for 4-6 months but since I can’t get the Tymlos filled for more than 90 days, which took me 1.5 months to get approved, I will not be able to escape the cold winter this season. I’m just lucky to currently have 3 pens to travel mid October - mid December. I also anticipate that it may be difficult this January to even get another prescription filled? I will have to search for different insurance since Ucare has discontinued their medicare advantage program. I’m hoping this will not be a problem once I get different insurance however it also took almost 2 months just to get the Tymlos approved since it was not on their formulary. Fingers crossed this will not be a problem come January on my new insurance, since I know I will need a new pen on January 9 2026 😨
I hope this information is helpful. I have gotten so much valuable information here and I hope to pass on my story to help others. It is early in my med journey but I wanted to give a shout out to those who are afraid of meds as I was and how important it is to gather information to help make a decision.

@lurawilson

That looks like a good early response - your P1NP almost doubled, and CTX rise fits with the expected turnover on Tymlos. HRT could sometimes affect how much these markers shift, so that might play a part too. If you’re curious, you could recheck at 6 and/or 12 months just to see the trend for further confirmation, but no need if your doctor’s fine with things. Hope you’ll keep us posted on your progress!