What Does This Blood Report Indicate?

Posted on Fri, 11 May 2018

Question: severe osteoporosis, seeing Endocrinologist at Univ of XXXXXXX due to pelvic fracture, broken foot, re-fracture of pelvis, all within one year and without accident or injury. I would like your opinion of my blood test results - osteocalcin serum 4.7, a low score; c-telopeptide 52, low score and parathyroid hormone 77, a higher end score. The specialist wants the Prolia out of my system prior to re-test. Please also tell me why a 24 hr. urine is important. All other labs normal. Dexa is -2.5, down from 2 yrs ago -2.9. have taken Forteo daily from Jan-July this year.

Answered by Dr. Mirjeta Guni (1 hour later)

Brief Answer:
About osteoporosis treatment:

Detailed Answer:
Hello and thank you for asking!

From your description, I can understand that you have been on treatment with Forteo and Prolia since January (?) and than Forteo was removed and you continued with Prolia up to now.

Now your treating physician has recommended to stop Prolia for a certain period and retest the above-mentioned exams?

I would say that C/N telopeptide are bone turnover markers and usually they are significantly decreased when the treatment is effective. But, they get back to previous levels after 12 months of Prolia discontinuation.

PTH level increases during treatment with Prolia but as far as I can understand your physician wants to differentiate if PTH is increased by Prolia or there is a parathyroid adenoma increasing it. That is why they suggested retesting after discontinuation of Prolia.

A 24-hour urine, in this case, would be of help to check urine calcium that in cases of parathyroid adenoma it will result high and in case of PTH increase by Prolia calcium will result low in urine.

Hope I have been clear and helpful. Feel free to ask further.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (40 minutes later)

I am a 12 year breast cancer survivor and have been on infusions since 5 years on Arimidex, first Reclast, then Prolia, followed up by Forteo dates mentioned in my medical history then back to Prolia. Would that change any of your response?
Thank you for so much information on my tests. XXXXXXX XXXXXXX

Answered by Dr. Mirjeta Guni (38 minutes later)

Brief Answer:
About elevated PTH;

Detailed Answer:
Welcome back!
No, It does not change the above-mentioned opinion.

Parathyroid adenomas are common in the women after 60-ies.
That is why they want to rule it out before continuing with Prolia.

An overproduction of parathyroid hormone by the parathyroid gland would aggravate osteoporosis and the treatment in these cases consists in removing the adenoma, improving the outcome of osteoporosis a lot.

Wish you good health.
Best wishes,
Dr.Mirjeta

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Above answer was peer-reviewed by : Dr. Arnab Banerjee