Why no bone marker tests before starting alendronate?

debocot, bone markers aren't mainstream, but should be. I'm curious about the bone health ortho that you saw and think you might fare better with an endocrinologist. Many endocrinologists are thinking that it is better for the osteoporotic patient to take an anabolic medication first. With -2,7 in the femur, you might want to at least hear a presentation of that information.
Your age could be a consideration because, in general, we lose the most bone during the first years of menopause
A look for other causes of osteoporosis could be important.
Alendronate works by attaching to the bone where it is the weakest. It prevents the cells that would dissolve that bone from attaching and causes their death. So your body collects the weakened bone and this collection increases your bone mineral density.
Additional calcium is needed because the bones store calcium and when they breakdown they provide calcium for the rest of the body.
Some doctors only run CTX a particle left in the blood when bones are dissolved. Normally. a CTX would be ordered before treatment and then again 3 to 6 months later. The drop in CTX would be20 to 50% if the drug is effective for you.
Welcome to the trenches.

@gently

Thanks so much for your thoughtful reply.

One thing confused me: “Your age could be a consideration because, in general, we lose the most bone during the first years of menopause.”

Were you saying the 5.7% loss of bmd in the femur neck is unusual bc of my age and so might warrant seeing an endocrinologist, or did you mean that it would have mattered more had it occurred in the first years following menopause, so at my age, anabolic might not be appropriate.

Thought I should the results, which are still sort of confusing to me.

I’ve been pretty bad about taking vitamins (forgetful), but I do eat a lot of dairy. I’m belatedly trying to get on top of it.

RESULTS: L1-L4 Total BMD values= 0.891 T-score= -1.4 Z-score= 0.6 Total Femur BMD values= 0.758 T-score= -1.5 Z-score= -0.1 Femur Neck BMD values= 0.551 T-score= -2.7 Z-score= -1.0

debocof, at younger than 50 it would be more likely that there could be secondary cause of osteoporosis.
Most of us lose bone because of hormonal changes, rather than dietary intake.
Did they measure the femoral neck on only one side? Is there any left or right notation. Do you have any pain or was there previous injury to the measured hip.
One of the drawbacks of dexa is that the foot has to be rotated internally so that the femur neck is parallel to the table. Misreadings in the femoral neck are not unusual. The occurrence of isolated femoral neck osteoporosis is low (about 5%).
I suspect you would benefit from seeing an endocrinologist.

Since there is no osteoporosis specialty you could definitely benefit from seeing either an endo or a rheumatologist (generally those two specialties are the ones suggested for osteoporosis). Bone markers (CTX, NTX, P1NP) sure seem important but some docs do them some don't. Mine did not; first appointment I was put on Fosamax, after a year on Fosamax I requested (found out what bone markers were on the internet) and got CTX and NTX, and my doc did run those tests again after 1 year on Reclast. Never had P1NP (maybe because I started on a bisphosphonate?) who knows.

@jozer

Turns out, my appointment late last year, prior to diagnosis was at the UCSF Bone Health clinic which is a multidisciplinary center combining rheumatology and endocrinology and ortho. This was prior to my diagnosis, and the doctor there told me to work with my gp if my scheduled DEXA were to came back showing osteoporosis. Even though the change came back showing a 5.7% decrease in one year, the doc (who actually is an endocrinologist) said by text when I followed up with my results to just work with my gp. I guess they don’t work with everyone who has osteoporosis?

Google UCSF Bone Health to get information about this program. I’m not allowed to post links yet.

@debocof Specialists may not see you if you don’t have severe osteoporosis or if you have not fractured. This was my experience. My gynecologist submitted a referral to a rheumatologist but it was denied and my primary care physician prescribed Fosamax.

I ended up with a fracture and that was when I was finally approved to see an endocrinologist.

I never had bone markers assessed until I started seeing an endocrinologist and that was only CTX. I’ve never had my P1NP measured.

@oopsiedaisy It's annoying that they want us to decline before the proper specialist can step in to help! I guess there's just not enough money in prevention and I find that infuriating.

@oopsiedaisy
we need our doctors to challenge these denials. The denials are made by non-medical insurance company claims adjusters. Whereas challenges usually involve medical personnel. I read somewhere that 75% of denials are reversed on appeal, but a greater percentage of denials are never challenged. ( I don't know how valid the 75% number is, though,)

@gently
It was my left hip, and yes, I started having pain there 3 summers ago along with lower left-side back and knee pain, only on that side.
I had an mri that showed a labrum tear, but no doc offered to repair it. It hasn’t been as painful the last 5 months as it had been, and it was rarely debilitating, as my knee took that prize. Pilates might have helped?
The doctor I saw in December, before this DEXA, actually is an endocrinologist who is the head of a skeletal heath speciality at UCSF. I’ve texted him again to ask about what could cause such sudden significant bmd loss (5.7%) in two active years, and to ask if bone markers might be appropriate prior to starting alendronate.
Now I’m worried that alendronate will make my bones more brittle, but I can’t constantly overthink treatment without driving myself nuts! I should’ve been given HRT, but my CA doctors have been just dialing it in, it seems, cause the benefits of HRT were known well before I’d been post-menopausal for 10 years (this is my 18th year).

debocof, so I wonder if left and right have the same density loss and if the chondral tear might have changed your weight bearing pattern.
Either of the compared dexas might not be accurate. They should be done on the same machine with the same tech which is almost impossible.
You might ask your GP for Forteo or Tymlos for faster protection of the vulnerable femoral neck. Both improve the vascularity of bone.
Women can lose 10 to 12% of bone mineral density in a year during menopause.