HOW TO KEEP A CLOSE EYE ON YOUR BONES

Quick Takes

🏗️ Your bones are never "done." Bone is living tissue that constantly chips away at little imperfections, and then rebuilds — a process called remodeling. Two proteins in your blood tell us which direction that process is heading right now: P1NP (building) and CTX (breaking down). Together they give a real-time read on bone health that a DEXA scan, taken every two years, simply can't provide.

⚖️ The ratio matters as much as the numbers. A high P1NP is generally good — active building. A high CTX is generally a concern — active breakdown. The balance between the two provides additional information. A low P1NP/CTX ratio has been independently linked to fracture risk, independent of bone density.

🎛️ These markers respond to some things you actually control. Resistance and impact exercise shifts P1NP upward within weeks. Calcium intake from food can lower CTX within hours. Sleep disruption — even a few weeks of it — suppresses P1NP without changing CTX, quietly tipping the balance toward net bone loss. The research is early in some of these areas, but the direction is consistent: lifestyle shows up in these markers.

🔍 You don't have to wait for a fracture to get data. Guidelines now allow clinicians to use a 3-month change in CTX or P1NP — rather than a repeat DEXA — to gauge whether a treatment or intervention is working. That's a meaningful shortcut. If you're starting a new program (exercise, supplements, medication), baseline markers give you something to measure against

A small-group course for people serious about bone health. Weekly video lessons, biweekly live discussions, and a supportive community — with a physician guiding you through every step of implementation.

Starting August 11, 2026.

🔬 Favorite Finds

1. This newsletter lists the factors you need to know about to improve your bones.

2. This workbook helps you implement these practices one step at a time.

3. My cohort-based (videos to watch at home plus virtual meetings every other week) Bone Course starting August 11, 2026.

Deep Dive

Are Your Bones Building or Breaking Down Right Now?

Most of us think about bone health in terms of DEXA scans — that every-few-years snapshot that tells you whether your density is holding. But there's a more dynamic way to track what's happening in your skeleton in real time: bone remodeling markers.

Two proteins — P1NP and CTX — are now the consensus "reference" markers for bone health monitoring, endorsed by the International Osteoporosis Foundation. P1NP reflects how actively your osteoblasts are laying down new bone matrix. CTX reflects how actively your osteoclasts are breaking old bone down. The ratio between them also helps inform you whether your skeleton is in a net building or net breakdown state right now — today — not two years from now.

These markers respond to medication, but also to lifestyle. Resistance training shifts P1NP upward. Sleep disruption suppresses it. Calcium from food lowers CTX within hours. Even your gut microbiome appears to influence them — certain bacterial patterns correlate with lower CTX levels, and probiotic trials have begun to reproduce that effect.

In this issue's deep dive, we walk through the evidence on each of these levers: what moves the markers, how large those effects are, and what to make of the emerging gut-bone axis research.

Read the full deep dive on the website →