Are Your Bones Rebuilding? Your Bone Turnover Markers Can Tell You

Updated: April 10, 2024

Reviewed By:
Lara Pizzorno – AlgaeCal Scientific Advisory Board Member
MDiv, MA, LMT
Best-selling author of Healthy Bones Healthy You! and Your Bones; Editor of Longevity Medicine Review, and Senior Medical Editor for Integrative Medicine Advisors.

You’ve begun taking AlgaeCal Plus, Strontium Boost and Triple Power, a fantastic supplement plan to increase bone mineral density and improve overall bone health, but how do you know if it’s working?

Going in for a DEXA scan is the best way to test your bone mineral density, but sometimes you have to wait longer than you’d like for your next scan.

Assessing your bone turnover markers (BTMs) is an excellent way to see what’s happening in your bones in present time. These markers give you information about the activity of your bone-building and bone-resorbing cells in real time, which means that you don’t have to wait to see shifts in their levels. 

In this article, we’re going to discuss what bone turnover markers are, when and why you want to check them, and how they can provide you with the information you need to ensure you’re on the right track.

The Bone Remodeling Process

Before we jump into the details of bone turnover markers (BTM), let’s first examine the process of bone remodeling. By understanding how your bones remodel themselves, you’ll better grasp the role of bone turnover markers and why they’re so crucial in helping you assess how well your bones respond to specific protocols.

Bone renewal consists of two coupled activities: resorption (or the breakdown) of old or damaged bone carried out by osteoclast cells whose activity releases growth factors and other nutrients that trigger the process new bone formation by osteoblast cells.

During normal healthy bone remodeling, these two processes are tightly coupled with osteoclasts and osteoblasts working together as a team in tiny little multicellular groupings called Basic Multicellular Units or BMUs.

Your BMU crews replace old bone with new bone, ensure your blood levels of calcium remain stable, and your body’s overall pH remains slightly alkaline, and in the process, release compounds that appear in your blood and urine. These are your bone turnover markers.

Therefore, each BTM acts as an indicator of a specific process that’s happening in your bones. 

The natural levels of BTMs will shift throughout your life due to changes in bone remodeling that occur with age. Bone turnover markers are highest in growing children, peak during puberty, then tend to remain at relatively low basal levels during adulthood until an increase is observed in postmenopausal women.


For this reason, the ranges for healthy BTMs you want to see on your lab reports are established from research conducted on young women between the ages of 35 and 45 when bone remodeling is low and balanced[1].

How to Get Your Bone Turnover Markers Checked

DEXA scan is the gold standard for testing bone density, so we highly encourage regular DEXA scans to ensure that your bones are healthy and where they need to be. That said, BTMs offer a fantastic adjunct to DEXA as you can assess your BTMs on a more frequent basis. 

You can talk to your healthcare provider about ordering regular BTM tests as you work on your treatment plan. It’s always a good idea to test your BTMs close to when you begin on new bone health supplements. This will give you a baseline to work with moving forward so you can compare your results to see how well your bone health plan is working.

Your medical insurance should cover these lab tests. In the U.S., most private insurance plans cover at least one bone turnover marker, as does Medicare under a National Coverage Determination.

doctor reviewing insurance policy

Interpreting Your Results

Lab ranges do vary, so it’s best to check your report to see the ranges used by the lab that ran your test, but in general, healthy levels of bone remodeling are indicated by the following ranges[2]: 

Markers of Bone Resorption:

  • CTx blood levels: 114–299 pg/ml
  • Urinary NTx/Creatinine: 9.22–24.8 nmol BCE/mmol creatinine

Markers of Bone Formation:

  • P1NP: 16.3–36.0 ng/ml
  • Bone ALP: 5.15–8.68 ng/ml

If you find that your BTMs for bone resorption (CTx)  are out of range on the high end, it indicates excessive bone turnover. If your BTMs for bone resorption (CTx) are out of range at the low end, it indicates osteoclast activity is suppressed, and remember, bone renewal is coupled. Osteoclast activity is needed to initiate osteoblast activity. If your BTMs for bone formation are out of range on the lower end, it indicates that you’re rebuilding bone too slowly. Ideally, your measurement for P1NP and CTx will both be around mid-range, indicating a healthy balance of bone resorption and bone formation. If your initial levels are out of balance, continue on your bone health plan and then re-test in 3-6 months. 

Healthy range for bone turnover markers

If you see that your levels are moving in the right direction, keep up with your plan.

However, if you notice that your levels are not improving, there are several factors that you can check to see what’s causing either an increase in bone turnover or inadequate new bone formation.

Bone Turnover Markers Explained

As mentioned, while getting a DEXA scan to assess bone mineral density is important, BTMs are helpful for evaluating bone health on a more frequent basis. In fact, within just 12 weeks (3 months), BTMs can tell you if the activities of your osteoclasts and osteoblasts are moving towards—or are already in — a healthy balance.

If you have type 1 or type 2 diabetes, it’s even more crucial that you check BTMs because bone mineral density tends to be less affected by diabetes, but bone health can still suffer. Therefore, DEXA reports often underestimate fracture risk in individuals with diabetes.[1]. 

Furthermore, if you’re taking anti-resorptive drugs, you retain and accumulate poor-quality bone due to their suppression of osteoclast activity, which you now know is required for osteoblast activity. As a result, you end up with an increase in BMD but also an increasingly greater risk of fracture. Checking your BTMs can provide insight beyond BMD and let you know how healthy your bones are from a fracture-risk standpoint[3]. 

There are two groups of BTMs: markers of bone resorption that are released by osteoclast activity and markers of bone formation that are released by osteoblast activity. Let’s take a look at each in more detail.

Markers of Bone Resorption

C-terminal telopeptide (CTx)

C-terminal cross-linking telopeptide of type I collagen is currently considered the key marker of bone resorption by the International Osteoporosis Foundation[4]. 

This BTM is derived from type 1 collagen via the action of osteoclasts (cells that break down bone). Both blood and urine tests will detect CTx, although blood is the superior option for accuracy.

N-terminal telopeptide (NTx)

Much like CTx, NTx is also derived from type 1 collagen via the action of osteoclasts. However, NTx is less accurate than CTx as a bone turnover marker because the test is often run in urine, which is a less reliable sample. If your doctor does run an NTx assessment, it should be run several times with pooled results to give you a more accurate assessment, as NTx levels in urine can fluctuate dramatically[1].

Tartrate-resistant acid phosphatase 5B (TRAP-5B)

In the case of chronic kidney disease, neither CTx nor NTx will be reliable markers for you because these BTMs accumulate when kidney function is compromised. 

As an alternative, you can test levels of Tartrate-resistant acid phosphatase 5B. This BTM’s blood levels are not affected by kidney function[5].

infographic for bone formation markers and bone resorption markers

Markers of Bone Formation

N-terminal collagen type I extension propeptide (P1NP)

N-terminal collagen type I extension propeptide, which is abbreviated as P1NP, is considered the key marker of bone formation. P1NP is derived from type 1 collagen, which is secreted by osteoblasts (bone-building cells).

There are two forms of P1NP that can be measured; 3-peptide or 1-peptide. When having total P1NP measured, your results will show both forms, but if you have chronic kidney disease (CKD), you’ll want to have “intact” P1NP measured only, which is the 3-peptide form. 

This is because a low glomerular filtration rate (GFR) will overestimate P1NP concentrations, giving you false results on your test. With “intact” P1NP, you’ll get a better idea of your true levels[6].

Osteocalcin

Osteocalcin is a calcium-binding enzyme secreted by mature osteoblasts, and it’s the most abundant non-collagen protein found in bone. Blood levels of osteocalcin follow a circadian rhythm, peaking around midnight when bone formation is at its height and then plummeting to its lowest levels around noon.

Because of osteocalcin’s circadian rhythm, if you are going to have your osteocalcin level checked, your blood must be drawn in the morning when you’re fasting.

Bone Alkaline Phosphatase (bone ALP)

Bone-Specific Alkaline Phosphatase (bone ALP) is another enzyme secreted by osteoblasts that plays a vital role in bone mineralization[7].

Alkaline phosphatase can be found throughout your body in different tissues and organs, including your intestines, liver, kidneys, and bones. When you test for bone-specific alkaline phosphatase, it tells you whether your osteoblasts are actively building new bone for you, as this BTM is released in proportion to the activity of bone-building cells.

It should be noted that current lab tests available for bone ALP may include the activity of the form of alkaline phosphatase found in the liver. Therefore, this BTM is not the best choice for you if you have any form of liver disease.

Factors That Can Affect BTMs

BTMs will be affected by any physiological process that’s inhibiting proper bone turnover. Therefore, if you do not see the results you would like to see with your treatment plan, you’ll want to check for secondary causes of osteoporosis, including insufficient weight bearing exercise, insufficient vitamin D, calcium, magnesium or trace minerals, insufficient protein consumption, digestive problems like low stomach acid or dysbiosis that impair your ability to absorb the nutrients your bones need, environmental toxins (like lead, mercury, cadmium, phthalates or pesticides), or conditions like hyperparathyroidism, hypo- or hyperthyroidism, subclinical hypercortisolism, and kidney or liver diseases (e.g., NAFLD, hepatitis)[8][9][10][11]. 

Furthermore, certain medications such as proton pump inhibitors, glucocorticoid medications, and SSRIs can affect your ability to absorb the nutrients your bones need and/or adversely affect your endocrine system and the activity of your bone building osteoblasts[12][13]. 

There are also a handful of factors to keep in mind that may impact the reproducibility of your BTM measurements:

  • Bone turnover increases in the winter and decreases in the summer. Therefore, if you’re testing throughout the year, you’ll want to keep these fluctuations in mind.
  • If you have recently had a fracture, your BTM levels will dramatically increase for at least six months[2].

Glucocorticoid therapy reduces the level of P1NP in a dose-responsive manner. For this reason, P1NP is only helpful in monitoring treatment of glucocorticoid-induced osteoporosis if the glucocorticoid dose is established and remains stable[14].

Takeaway

Now that you know more about how to assess what’s happening with your bone remodeling process, you’ll want to ensure you’re taking the right supplements to support bone health.

First and foremost, to increase bone mineral density, you must have a proper supply of vitamins and minerals like those found in AlgaeCal Plus. If your bone mineral density is already lower than you would like it to be, add Strontium Boost to slow down bone resorption, speed up bone formation, and triple your gains in bone density.  

To address oxidative stress that is often at the root of bone loss, consider taking a high-quality omega-3 like Triple Power Omega-3 Fish oil

Have your BTMs tested, stay committed to your bone health plan and test your BTMs again in 3 to 6 months to make sure everything is moving in the right direction!

FAQs

What is a bone turnover marker test?

A bone turnover marker test assesses biochemical markers for bone resorption and bone formation. This test can give you information about what is happening in your bone remodeling process.

What are biomarkers for bone turnover?

Biomarkers for bone formation include N-terminal collagen type I extension propeptide (P1NP), osteocalcin, and Bone Alkaline Phosphatase (bone ALP). Biomarkers for bone resorption include C-terminal telopeptide (CTx) and N-terminal telopeptide (NTx).

What is CTx bone marker?

C-terminal telopeptide (CTx) is derived from type 1 collagen via the action of osteoclasts; its presence indicates that bone resorption is taking place.

What is a good CTx score?

CTx blood levels should be within the mid-range of 114–299 pg/ml, indicating a healthy balance of bone resorption and bone formation. A CTx out of range on the high end indicates excessive bone turnover. CTx out of range on the low end indicates osteoclast activity is suppressed. Some osteoclast activity is needed to initiate osteoblast activity. If your BTMs for bone formation are out of range on the lower end, it indicates that you’re rebuilding bone too slowly.

What does high bone turnover mean?

High bone turnover is associated with more rapid bone loss than bone formation and can be associated with a range of factors, including age, nutritional status, certain medications, digestive issues, environmental toxins and more. For a full discussion of these issues, please see the book Healthy Bones, Healthy You!.

References

  1. Greenblatt, Matthew B., Joy N. Tsai, and Marc N. Wein. “Bone turnover markers in the diagnosis and monitoring of metabolic bone disease.” Clinical chemistry 63.2 (2017): 464-474.
  2. Eastell, Richard, et al. “Diagnosis of endocrine disease: bone turnover markers: are they clinically useful?.” European journal of endocrinology 178.1 (2018): R19-R31.
  3. Ashrafi, Mehran, et al. “On the effect of antiresorptive drugs on the bone remodeling of the mandible after dental implantation: a mathematical model.” Scientific Reports 11.1 (2021): 1-20.
  4. Szulc, Pawel. “Bone turnover: Biology and assessment tools.” Best Practice & Research Clinical Endocrinology & Metabolism 32.5 (2018): 725-738.
  5. Yamada, Shinsuke, et al. “Utility of serum tartrate‐resistant acid phosphatase (TRACP5b) as a bone resorption marker in patients with chronic kidney disease: independence from renal dysfunction.” Clinical endocrinology 69.2 (2008): 189-196.
  6. Tridimas, Andreas, Anna Milan, and Eileen Marks. “Assessing bone formation in patients with chronic kidney disease using procollagen type I N-terminal propeptide (PINP): The choice of assay makes a difference.” Annals of Clinical Biochemistry 58.5 (2021): 528-536.
  7. Masrour Roudsari, Jila, and Soleiman Mahjoub. “Quantification and comparison of bone-specific alkaline phosphatase with two methods in normal and paget’s specimens.” Caspian journal of internal medicine 3.3 (2012): 478-483.
  8. https://www.ncbi.nlm.nih.gov/books/NBK470166/
  9. Haffner‐Luntzer, Melanie, et al. “Hypochlorhydria‐induced calcium malabsorption does not affect fracture healing but increases post‐traumatic bone loss in the intact skeleton.” Journal of Orthopaedic Research 34.11 (2016): 1914-1921.
  10. Yatsonsky II, David, et al. “Linkage of microbiota and osteoporosis: a mini literature review.” World Journal of Orthopedics 10.3 (2019): 123.
  11. Heidelbaugh, Joel J. “Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications.” Therapeutic advances in drug safety 4.3 (2013): 125-133.
  12. Pizzorno, J., & Pizzorno, L. (2021). Commonly Prescribed and Over-the-Counter Drugs as Secondary Causes of Osteoporosis—Part One. Integrative Medicine: A Clinician’s Journal, 20(2), 8.
  13. Pizzorno, J., & Pizzorno, L. (2021). Commonly Prescribed and Over-the-Counter Drugs as Secondary Causes of Osteoporosis—Part Two. Integrative Medicine: A Clinician’s Journal, 20(2), 8.
  14. Eastell, Richard, et al. “Bone formation markers in patients with glucocorticoid-induced osteoporosis treated with teriparatide or alendronate.” Bone 46.4 (2010): 929-934

Article Comments

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  1. Wendy Olson

    April 15, 2023 , 5:28 am

    I’m trying to find a good bone Dr. In the 91401 or close to area . Can you help .

  2. Yoori AlgaeCal

    April 17, 2023 , 6:19 pm

    Hi Wendy,

    Thank you for reaching out to us! We are truly sorry that we do not have any recommendations for a bone specialist near the area, but we hope you can find one soon! If you have any questions along your bone-health journey, please feel free to give us a call at 1-800-820-0184. We are always happy to help :).

    – Yoori @ AlgaeCal

  3. Lori Lee

    April 15, 2023 , 6:26 am

    I had a humeral head fracture on 12/20/22, and was diagnosed with Osteoporosis -4 on T scale in March of 2023. I have started AlgeaCal, and I am still on my first bottle…my question is should I wait to have labs for BTM levels checked until the 6-month mark from the date of my fracture?

  4. Yoori AlgaeCal

    April 17, 2023 , 6:22 pm

    I’m so sorry to hear of your recent head fracture, Lori. I hope you’re getting all the support you need! We would recommend that you wait as fractures will dramatically increase BTM levels for at least 6 months. If you do have further questions, please give us a call at 1-800-820-0184 :).

    – Yoori @ AlgaeCal

  5. Laura A. Bowling

    April 15, 2023 , 8:21 am

    Interesting article. Please let me know what exact test I should ask my doctor to order at the lab. Thank you, Laura Bowling

  6. Yoori AlgaeCal

    April 17, 2023 , 6:24 pm

    We are glad to hear you enjoyed reading the article, Laura! If you’re interested in getting your Bone Turnover Markers checked out, you can talk to your healthcare provider about ordering regular BTM tests. It’s always a good idea to test your BTMs close to when you begin on new bone health supplements. This will give you a baseline to work with moving forward so you can compare your results to see how well your bone health plan is working. I hope this helps!

    – Yoori @ AlgaeCal

  7. susan atkinson

    April 15, 2023 , 8:37 am

    Thank you Lara for this new information about BTM’s. Side question- I enjoy drinking the health/vinegar drink Kombucha (about 1 cup @ day) . Would that affect my bone health? I ask because I know when I make bone broth, I add vinegar to the water to encourage the bones to release their minerals. Susan

  8. Chelsea Dugas

    April 17, 2023 , 1:09 pm

    Great question, Susan! Kombucha is a great addition to your diet as it contains glucuronic acid, a component that helps in the maintenance of healthy skin, connective tissues, as well as bones! So enjoy your kombucha! 🙂

    – Chelsea @ AlgaeCal

  9. Kathy LaBlue

    April 15, 2023 , 10:26 am

    Very interesting read. Do most doctors grasp this concept & readily order tests? I have been getting constipated since starting this new regimen of bone building. I also have had an episode of diverticulitis with abcesses & cannot afford to get constipated & run the risk of another episode of diverticulitis.. What is a good bowel regimens to combat this issue? I take miralax (1 cap full in morning coffee) daily & take bisacodyl tabs on a PRN basis. I am also taking the Osteo MD supplement instead of AlgaeCal because it was listed to be better & was number one. Now I see that it is recommended to take triple fish oil. This was not suggested until I read this article! Help! I need all the help I can get.

  10. Yoori AlgaeCal

    April 17, 2023 , 6:33 pm

    Great question, Kathy! My understanding is that not all doctors readily order these tests, but you can certainly ask for one to be ordered! I’m truly sorry to hear of all the trouble you’re going through. I highly recommend giving us a call at 1-800-820-0184 for personalized support. Any of our Bone Health Consultants would be more than happy to help. We look forward to speaking with you!

    – Yoori @ AlgaeCal

  11. Deborah Denton

    April 30, 2023 , 5:03 am

    Kathy, I had a problem with constipation too – until I started eating prunes daily! They are recommended for healthy bones as well.

  12. GrayMare

    April 15, 2023 , 1:37 pm

    For years I’ve heard that chocolate, cocoa, is good for bone health, I’ve even had professionals recommend this to me for bone health. Now, I see above, in the paragraph heading:  “Factors That Can Affect BTMs” some, potentially contradictory information, Here’s the quote:  
    “BTMs will be affected by any physiological process that’s inhibiting proper bone turnover. Therefore, if you do not see the results you would like to see with your treatment plan, you’ll want to check for secondary causes of osteoporosis, including insufficient weight-bearing exercise, insufficient vitamin D, calcium, magnesium or trace minerals, insufficient protein consumption, digestive problems like low stomach acid or dysbiosis that impair your ability to absorb the nutrients your bones need, environmental toxins (like lead, mercury, cadmium, phthalates or pesticides), or conditions like hyperparathyroidism, hypo- or hyperthyroidism, subclinical hypercortisolism, and kidney or liver diseases ….”
    Now, my QUESTION: When I buy cocoa powder, many times I see the warning label on the package warning about CADMIUM dangers in cocoa. Can anyone shed some light on this subject for me?  Good outweighs the bad? How? Or vice versa?  I’m even more confused now. THANKS for your help!  

  13. Brianne AlgaeCal

    April 18, 2023 , 9:49 am

    Hi there GrayMare,

    Thanks so much for your question! While this is a little outside our area of expertise, we do know that cocoa provides the body with an abundance of antioxidants, flavonoids, and minerals that are needed to support bone health! Heavy metals are often found in soil, and this is how they end up in the foods we eat. Our suggestion would be to enjoy cocoa and chocolate, like anything, in moderation. Ultimately, at this time, it seems like more research is needed to determine the exact cause and effect influences chocolate consumption has on the bones.

    I hope this helps!

    – Brianne @ AlgaeCal

  14. Linda Marshall

    April 16, 2023 , 12:25 am

    complicated could not understand

  15. Yoori AlgaeCal

    April 17, 2023 , 6:26 pm

    We certainly understand that this may be too much information to take in at once, Linda! If you have any questions about this article and would like to discuss this with us, please give us a call at 1-800-820-0184 for personalized support :). We are happy to help!

    – Yoori @ AlgaeCal

  16. Lori

    April 16, 2023 , 9:35 am

    Where do I start. In Alberta you are allowed a bone density test every 5 years. Are there private companies that are specific to females and tests regarding this article?

  17. Brianne AlgaeCal

    April 18, 2023 , 9:27 am

    Hello Lori, thanks for your comment!

    If you are not able to get these checked on with your primary care physician, I would suggest looking for a Functional Medicine Practitioner in your area that may be able to help with these! To find one in Alberta, click HERE! 🙂

    – Brianne @ AlgaeCal

  18. Carolyn Will

    April 17, 2023 , 1:03 pm

    AlgaeCal, I was told, improved scores on DEXA scans. Not for me. My scores have not improved after about 18 months on AlgaeCal and Strontium Boost. I recently learned the thyroid is not functioning properly.

  19. Brianne AlgaeCal

    April 18, 2023 , 9:52 am

    We’re so sorry to hear you didn’t get the results you were expecting, Carolyn. We guarantee your results and definitely want to make this right, so please email [email protected] or call 1-800-820-0184 (USA & Canada toll-free) to speak with one of our Bone Health Consultants. We look forward to speaking with you and supporting your bone health journey going forward!

    – Brianne @ AlgaeCal

  20. Teresa

    May 8, 2023 , 6:09 am

    I need an online practitioner to order my bone maker tests in the United States. Please send me contact information!

  21. Manja

    May 10, 2023 , 10:09 am

    Hi Teresa! I’m sorry that we do not provide contact information of an online practitioner and we appreciate your understanding. You can talk to your healthcare provider about ordering regular BTM tests as you work on your treatment plan. Your medical insurance should cover these lab tests. In the U.S., most private insurance plans cover at least one bone turnover marker, as does Medicare under a National Coverage Determination. I hope this helps!

    – Manja @ AlgaeCal

  22. Lynda K . Lehr

    May 20, 2023 , 3:10 pm

    I found the article to be very interesting & informative . A couple of years ago I tried Algacel & for whatever reason, it caused me to have bloating , flatus & diarrhea . I ended up having to call the co . & returning the unused supplements . I was really disappointed , since I was Dx . with osteoporosis. I had done research & found your product to be a possibility , was so disappointed it caused so many gastric issues . I am wondering why that happened ??

  23. Brianne AlgaeCal

    May 23, 2023 , 9:46 am

    we’re so sorry to hear of this Lynda. It’s definitely unusual for these types of things to happen with AlgaeCal, as it is generally very well tolerated. We do understand though that everyone is different, with individual sensitivities. That said, we’d love to have the opportunity to support you, so please reach out to us at 1-800-820-0184 (USA & Canada toll-free), or [email protected], so we can explore this with you in more detail.

    I hope this helps!

    – Brianne @ AlgaeCal

  24. Rose O’Connor

    July 6, 2023 , 9:42 pm

    Hi,
    I just received the result of the CTx test. My result was 234 pg/ml. I see that the normal range is 114-299. What does this mean exactly? I have not talked to my doctor yet.

  25. Samantha AlgaeCal

    July 7, 2023 , 6:49 am

    Great question, Rose! According to our Bone Health Expert Lara, when your CTx results are within normal range, this indicates balanced and not excessive bone remodelling. Of course, it is always best to check in with your healthcare professional for further information! 🙂

    – Sam @ AlgaeCal

  26. Jean Martin

    July 24, 2023 , 8:13 am

    Thanks so much for this article. I have been on my own in trying to find a good calcium supplement for the past couple of years. I have pain that started in shins and has moved up to thighs mostly at night. now pain is on a daily basis. for the past year I have been asking drs. if I am taking too much calcium or too little. blood test show I am okay. Now I can ask for more specific tests. I stopped taking all supplements and pain was better. Now its getting more frequent. Drs. seem to dismiss my symptoms. I am calling today for a new dexa scan and these blood tests.

  27. Brianne AlgaeCal

    July 25, 2023 , 7:40 am

    Gosh, Jean, we’re so sorry to hear about the pain and discomfort you are in, and we hope you are getting the needed support at home. You might find the exercises in THIS BLOG ARTICLE to be helpful in relieving some of this. You may also benefit from our product called Triple Power Fish Oil – this potent combination of omega-3s, turmeric, and astaxanthin is a powerful natural pain reliever. We would encourage you to reach out to us at 1-800-820-0184 (USA & Canada toll-free) for any questions! 🙂
    – Brianne

  28. Dave Regiani

    September 7, 2023 , 1:19 pm

    What is the cost of the tests?

  29. Yoori AlgaeCal

    September 7, 2023 , 4:34 pm

    Great question, Dave! As the cost of BTM tests vary between clinics, we suggest reaching out to your doctor for accurate information :). Please let us know if you have any other questions!

    – Yoori

  30. Virginia Waterstreet

    September 12, 2023 , 11:44 am

    In general, how willing will a PCP or endocrinologist be to allow for this test? I went to an endocrinologist 2 years ago and she did not recommend any tests. She ‘Knew’ my osteoporosis was just a genetic cause and wanted me on Prolia. I just keep taking AlgaeCal. (there has been some improvement). Also, I’m on Medicare and have a feeling that this test won’t be covered…do you have any insight to this as well? Thanks!

  31. Yoori AlgaeCal

    September 12, 2023 , 7:57 pm

    Thank you for reaching out, Virginia! We’ve had many community members who were able to ask their doctors to order them BTM tests, and we hope you can work with your doctor on this! To determine whether a bone turnover marker test is covered by Medicare, it is recommended to contact Medicare directly :). I hope this helps!

    – Yoori

  32. Mary Lynn Schriner

    December 22, 2023 , 3:57 am

    Good morning
    Are there any home blood tests that are available at this time?
    Thanks

  33. Samantha AlgaeCal

    December 22, 2023 , 7:20 am

    Great question, Mary! As far as I know, there are no at-home blood tests to check bone turnover markers. However, if you want to know your Omega-3 and Vitamin D levels, we have at-home test kits available for both. You can find more information about the Omega-3 test kit HERE and the Vitamin D test kit HERE. I hope this helps! 🙂
    – Sam

  34. Dianne Rogers

    April 12, 2024 , 7:50 am

    how do you feel about the use of almond milk for calcium?

  35. Yoori AlgaeCal

    April 15, 2024 , 2:41 pm

    Thank you for reaching out, Dianne! As for calcium content, there’s actually quite a lot of calcium in almonds, but it’s almost all lost during the manufacturing process. So many brands offer calcium-fortified almond milk, meaning they add extra calcium after the fact. For more details, please visit our blog article HERE, and scroll down to “Does Almond Milk Contain Calcium?” section. I hope this helps! 🙂

    – Yoori

  36. Kathi Cupery

    April 13, 2024 , 7:11 am

    What is the name of the blood test/s i should ask my primary that i should have to
    determine the measurement of my bones and how often should i have these tests?

  37. Yoori AlgaeCal

    April 15, 2024 , 3:29 pm

    Thank you for reaching out, Kathi! As the article suggests, assessing your bone turnover markers (BTMs) is an excellent way to see what’s happening in your bones in present time. These markers give you information about the activity of your bone-building and bone-resorbing cells in real time. You can ask your primary to run a CTx or NTx testing + P1NP or Bone ALP testing.

    1. You can check the marker of bone resorption with CTx or NTx testing (CTx is more accurate). If you find that these numbers are out of range on the high end, it indicates excessive bone turnover.
    2. You can check the marker of bone formation with P1NP or Bone ALP testing. If your BTMs for bone formation are out of range on the lower end, it indicates that you’re rebuilding bone too slowly.

    Ideally, your measurement for bone resorption marker and bone formation marker will both be around mid-range, indicating a healthy balance of bone resorption and bone formation. If your initial levels are out of balance, continue on your bone health plan and then re-test in 3-6 months.

    I hope this helps, Kathi! Please feel free to give us a call at 1-800-820-0184 (US & Canada Toll-free) or email [email protected] if you have any follow-up questions! 🙂

    – Yoori

  38. Natalie Trigilio

    April 14, 2024 , 5:45 pm

    Two questions: one, some of these tests aren’t done by my labs, so dr. can’t request. Do you have recommendations for labs I can use?
    Two, what can I do if my Ctx is high (432) which I understand indicates high bone turnover?
    Thank you,
    Natalie

  39. Yoori AlgaeCal

    April 15, 2024 , 3:47 pm

    Thank you for reaching out, Natalie! While we do not have recommendations for specific labs, you may want to consider looking into specialty laboratories or diagnostic centers that specialize in bone health assessments. Some larger medical centers or hospitals may also offer these tests as part of their specialty services. It’s worth discussing with your healthcare provider to see if they can recommend a specific laboratory or facility that can perform the BTM tests you need.

    We are sorry to hear that your CTx number is high, Natalie. We suggest following up with your doctor for further evaluation and management. Your doctor may recommend additional tests, such as bone density scans (DEXA scans), to assess your bone health and determine the underlying cause of the high Ctx levels. Treatment options for high bone turnover may include lifestyle modifications (such as dietary changes and exercise), and possibly supplements to support bone health.

    Natalie, if you are interested in a natural approach to support bone health, AlgaeCal is the only calcium supplement clinically supported to increase bone density, and our Strontium Boost helps to balance out our bone remodeling process by increasing bone formation while decreasing bone resorption. You can discuss with your doctor if our Bone Builder Pack (AlgaeCal Plus + Strontium Boost) is a good fit for you! HERE is our Doctor Information Sheet for your convenience.

    Please feel free to give us a call at 1-800-820-0184 (US & Canada Toll-free) or email [email protected] for more information! 🙂

    – Yoori

  40. Mitch

    April 27, 2024 , 3:39 pm

    Please confirm that the blog has accurate Healthy Ranges, or whether there are similarly-named but different cTx tests. My health provider did the cTX test for me, and sent it to Utah’s ARUP Laboratory. My result was also very high (508), but ARUP listed the normal range as 132 – 752 pg/mL, which is very different than what’s in the blog.

    I was with another health provider in 2019, and my result was 574 then, with a reference range of 38 – 724

  41. Yoori AlgaeCal

    April 29, 2024 , 2:22 pm

    Thank you for reaching out, Mitch, and great question! Lab ranges do vary, so it’s best to check your report to see the ranges used by the lab that ran your test, but in general, a healthy range of CTx is 144-299 pg/ml. We suggest further discussing your CTx level with a healthcare professional, who can take into account individual medical history and other relevant factors :).

    – Yoori

  42. Gillian

    April 16, 2024 , 10:20 am

    Hello Algaecal,
    I am on my first bottle of Algaecal Plus & strontium and I am searching for a good collagen to add to my regimen. I used to take VP with hyaluronic acid and amino acids before they changed it.

    Thank you,

  43. Yoori AlgaeCal

    April 16, 2024 , 2:55 pm

    Thank you for reaching out, Gillian! We are sorry that we do not have a recommendation for a specific brand of collagen, but HERE is our blog article on “Collagen and Healthy Bones” for your interest :). Please let us know if you have any follow-up questions.

    – Yoori

  44. Bette L Honea

    April 19, 2024 , 11:00 pm

    This is a great article, thank you so much for creating it. I’m currently about 6months into a 12 month schedule of bone injections for my osteoporosis. How would this affect my scores? My doctor ordered a NTx which came back with a level of 27. According to your article, this is still out of range on the high end. I have a visit next week for my next shots and am going to ask about testing for the markers of bone formation. Any advice is greatly appreciated.

  45. Yoori AlgaeCal

    April 22, 2024 , 3:28 pm

    Thank you for reaching out to us, Bette! While we would love to address your question, we suggest reaching out to your doctor, as we are not medical professionals and this falls outside our scope of expertise. Please feel free to share our blog article with your doctor!

    – Yoori

  46. Linda Lemke

    April 30, 2024 , 7:17 am

    Very informative article!

  47. Yoori AlgaeCal

    April 30, 2024 , 4:14 pm

    Thanks so much for your comment, Linda! We’re so happy you have found this article informative! 🙂

    – Yoori

  48. Wendy Lambert

    May 1, 2024 , 7:11 am

    I really appreciate the info in this article. Being able to monitor results when making changes in supplements is so important, and you have included healthy ranges so that we can make sense of the test results. I noticed that you did not mention a healthy range for osteocalcin though. How do we know if the results of this test are good or not?

  49. Samantha AlgaeCal

    May 1, 2024 , 12:11 pm

    Thank you for your feedback, Wendy! In regard to healthy/normal ranges of osteocalcin, when blood work is taken, the reports typically mention normal ranges as reference. I hope this helps! 🙂 Please let us know if you have any further questions.
    – Sam

This article features advice from our industry experts to give you the best possible info through cutting-edge research.

Lara Pizzorno
MDiv, MA, LMT - Best-selling author of Healthy Bones Healthy You! and Your Bones; Editor of Longevity Medicine Review, and Senior Medical Editor for Integrative Medicine Advisors.,
Dr. Liz Lipski
PhD, CNS, FACN, IFMP, BCHN, LDN - Professor and Director of Academic Development, Nutrition programs in Clinical Nutrition at Maryland University of Integrative Health.,
Dr. Loren Fishman
MD, B.Phil.,(oxon.) - Medical Director of Manhattan Physical Medicine & Rehabilitation and Founder of the Yoga Injury Prevention Website.,
Prof. Didier Hans
PHD, MBA - Head of Research & Development Center of Bone Diseases, Lausanne University Hospital CHUV, Switzerland,