What was Your P1NP Increase on Tymlos at 1 Month?

Hi, Cathy,
we were discussing this earlier, years ago.
I'm not much help I'm on Forteo and my P1NP took four months to move from 67 to 73 Do you really have a doctor ordering bone markers after one month. Tymlos is said to peak at one month and the remain high. When will you retest. I'd like to see more postings of bone marker number. so thanks.
https://connect.mayoclinic.org/discussion/p1np-number-on-tymlos/.

@gently Yes!! I've had the P1NP tested 4 times, since my osteoporosis Dx last summer (Aug. 2025). First time by my PCP, so endo could have as much info as possible on my first visit. CTX has been tested twice....baseline and while on Evenity.

P1NP (Bone Formation) Trending
----------------------------
1) 08/28/25: Pre-Tx = 55
2) 12/16/25: Evenity #1 = 85
3) 02/02/26: 1-Mo-Post- Evenity #2 (1/2 dose) = 52
4) 04/13/26: Tymlos (19 full + 4 half injects) = 93

@gently

Oh, my provider already sent a retest order for CMP, P1NP, and iPTH for 3 weeks from my last test....likely due to side effects I'm dealing with that prompted me to reduce to 1/2-dose of Tymlos, after 19 injections.

@cathyf31 how do you convince a doctor to test P1NP?

@blueberre I didn't. The provider told me, as soon as Tymlos had been approved by my insurance company (on appeal) that she just put in orders to test CMP, P1NP, and iPTH in 4 weeks. She also added a 24-hr calcium urine test, only b/c I had a slightly positive one at baseline at the time of my original diagnosis and I have a history of kidney stones. As soon as my results came in and although all labs were good, she immediately put in repeat lab orders (minus the urine) for 3 weeks, due to side effect issues that caused me to go to half-dose (4 clicks/40 mcg). My provider is good and stays on top of things.

Apparently I need new doctors.

@blueberre Certainly have a conversation with them. It's ok to fire a doctor, if/when it's not a good fit or your needs are not being met. Do some research on reputable sites and maybe print out that info and take it with you, when you have your conversation.

@cathyf31, it looks like you had a very brief course of Evenity (a couple of months?) before switching to Tymlos. It’s fascinating to see your P1NP response mapped out like this. The surge in p1np after transitioning to Tymlos is really impressive! Will you have follow-up btm labs to track Tymlos' progress? You mentioned you've had CTX tested twice as well. Would you be open to sharing those results? It will be interesting to see how your markers were moving together.

@mayblin

Below is the info, including the CTX results. Please note that I only had one and a half treatments with Evenity and tonight will be my 29th Tymlos injection (19 full + 8 half-doses). I do not anticipate my doctor continuing to check CTX anytime soon, as Tymlos is not an anti-resorptive. Although, I haven't asked, as Tymlos is new to me for the past 1 month. I will try to remember to ask her about that next time I speak or message with her. Due to my side effects, she is testing more frequently than what I trust is typical. As soon as she started getting my results from my first round of blood & urine work at 3 weeks (all good), she told me she just submitted an order to repeat again in 3 weeks (just the CMP, P1NP, and iPTH).

Trending for P1NP
(Bone Formation Marker):
--------------------------
1) 08/28/25: Pre-Tx = 55
(CTX = 492)

2) 12/16/25: Evenity #1 = 85

3) 02/02/26: 1-Mo-Post- Evenity #2 (1/2 dose) = 52
(CTX = 544)

4) 04/13/26: Tymlos (19 full + 4 half injections) = 93

@cathyf31 your doctors are soo good.