Even in people without osteoporosis, the bone resorption markers deoxypyridinoline (DPD) and pyridinoline (PYD) crosslinks can be higher due to:
- High cortisol or chronic stress (endogenous glucocorticoids accelerate bone turnover).
- Hyperthyroid or high-normal thyroid hormone levels.
- Chronic inflammatory states (e.g., mast cell activation, mold-related inflammation, autoimmune activity) — these increase osteoclast activity.
- Low estrogen or perimenopausal fluctuations, even before overt bone density changes.