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P1NP
P1NP, or procollagen type 1 propeptide is collagen derived from type 1 collagen. In addition, P1NP is the most common type of collagen that tends to be found in bone. Not only is P1NP the preferred marker of bone formation, but its serum levels are also a key part in monitoring multiple bone formation and antiresorptive therapies. In people with osteoporosis and normal kidney function, the main form of P1NP in serum is the trimeric form while P1NP can also be found as a monomer in people with osteoporosis. P1NP is metabolized in the liver and people with liver disease might have higher P1NP levels than normal.

Osteoporosis
Because P1NP levels are a good marker of bone formation, they are helpful for monitoring antiresorptive and anabolic therapies including in people who suffer from osteoporosis. P1NP can be a key factor in the identification of ailments and diseases associated with high bone turnover rates, such as osteoporosis.

Before the beginning of osteoporosis therapy, a serum test can be performed to determine a persons baseline P1NP levels. Three to six months after starting any form of osteoporosis treatment, there should be a substantial change from someone's originally recorded baseline P1NP level. This substantial change indicates a therapeutic response.

Collection
In general, P1NP levels should not be used to test for osteoporosis as they alone are not a good indicator of such. In addition, P1NP collection should always happen around the same time of day because levels can vary depending on the time of day.

Reference Values
According to mayo meical laboratories, normal serum levels of P1NP in adults are as follows: (No exact values have been indentified for youths, specifically if under 18 years of age)
 * Adult males: 22-87 mcg/L
 * Adult female premenopausal: 19-83 mcg/L
 * Adult female premenopausal: 16-96 mcg/L