Questions about my CTX and Osteocalcin test results

Hi @255anny if your last injection is on 9/30, then your bone markers reflected ~month 11 of evenity. Clinical trial data showed that CTX was approximately 26% (median) below baseline, and OC was approximately 15.5% (median) below baseline at month 12. An absolute value of CTX 75 is low but it will change, since CTX increases above baseline value within 3months after discontinuation of evenity according to the manufacturer. You could ask your endo if your reclast infusion timing will be based on CTX testing results after the cessation of evenity. If so, how frequently will CTX be monitored and at which value (range) will it be appropriate for reclast infusion.

As far the association between low CTX and negative bone effects such as AFF and ONJ, my understanding from readings is that they rarely occur during first few years of bisphosphonates treatment. Hope this wont be a stress point at this point of your treatment.

My doctor had me wait two months after Evenity, before Reclast, saying it takes time for Evenity to "mineralize." Two months was the limit though.

Keith McCormick would tell you to wait for a higher CTX. One of my endos said studies show it doesn't matter but it seems reasonable, with a CTX that low, to wait. Evenity is anti-resorptive so that might be why the CTX is low.

As you can tell, like everything else, little is actually known since Evenity is so new, and there are differences of opinion. Some docs like mine don't do bone markers at all. There may be other tests that tell you more about what is going on in bones.

If it were me, I would maybe talk to McCormick and consider waiting until the CTX is over the value that McCormick suggests. Maybe someone on here remembers- over 100? My copy of his book is in storage 🙂

I would love an appt with McCormick just for advice and clarification, but I bet the wait is quite long. I was searching his book last night, trying to get an idea of what is going on. It was late and I was tired so I didn’t absorb any info. I do remember something he wrote about results under 100 are dangerously low. I think that’s what I read. 😆 I will review those sections tonight. And to your point that a lot of doctors don’t use the markers, I can see why. I know they are highly variable and we need to follow blood draw guidelines. I did all that but realized I used a small scoop of collagen in my coffee the day before. But would that small amount really matter? And are there guidelines for number ranges? Like over this number, you start or below you don’t. It’s confusing for sure!

I just check my scribbled notes from my last appt with my Dr. She said results under 200 we will wait and retest CTX mid-October.

Do you have a patient portal with that doctor? I use it all the time to read their notes from appointments. Sometimes I do wonder if we were in the same room.

Yes, I do. And I agree with you - I'm always thinking we didn't discuss that, haha.. Maybe they have to include for insurance or something. But it should be clear..

According to McCormick, CTX should be over 100 pg/mL. He seems to think that osteocalcin results have limited accuracy. Page 152 of Great Bones paperback has full details.

Thank you ... it's all so confusing. Going to my book!