Biomarkers as therapy monitoring for postmenopausal osteoporosis: a systematic review

Abstract

Background Biochemical markers of bone turnover (BTMs), such as bone alkaline phosphatase (bALP), procollagen type I N propeptide (PINP), serum cross-linked C-telopeptides of type I collagen (bCTx), and urinary cross-linked N-telopeptides of type I collagen (NTx), are commonly used for therapy monitoring purposes for osteoporotic patients. The present study evaluated the potential role of BTMs as therapy monitoring. Methods All randomized clinical trials (RCTs) comparing two or more pharmacological treatments for postmenopausal osteoporosis were accessed. Only studies that reported the value of bALP, PINP, bCTx, and NTx at last follow-up were included. A multivariate analysis was performed to assess associations between these biomarkers and clinical outcomes and rate of adverse events in patients with postmenopausal osteoporosis. A multiple linear model regression analysis through the Pearson product-moment correlation coefficient was used. Results A total of 16 RCTs (14,446 patients) were included. The median age was 67 years, and the median BMI 25.4 kg/m2. The median vertebral BMD was 0.82, hip BMD 0.79, and femur BMD 0.64 g/cm2. The ANOVA test found optimal within-group variance concerning mean age, body mass index, and BMD. Greater bALP was associated with lower femoral BMD (P = 0.01). Greater NTx was associated with a greater number of non-vertebral fractures (P = 0.02). Greater NTx was associated with greater rate of therapy discontinuation (P = 0.04). No other statistically significant associations were detected. Conclusion Our analysis supports the adoption of BTMs in therapy monitoring of osteoporotic patients. Level of evidence Level I, systematic review of RCTs.

Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis

“…Greater CTx values may lead to a reduction in BMD and T-score [ 63 , 64 ]. BTMs are considered to have potential clinical utility as therapy monitors and prediction tools for complications [ 63 , 65 ].…”

Associations of Sex Hormone-binding Globulin with Bone Mineral Density Among US Adults, NHANES 2013–2016

“…Personal and societal costs of osteoporosis are increasing as the ageing population increases. Aside from age, gender and diabetes status are considered to attribute to osteoporosis, 17 which represents a silent epidemic that carries significant mortality and morbidity. The main focus of clinicians is to detect the factor which may effect osteoporosis as early as possible.…”

Fragility Fractures: Risk Factors and Management in the Elderly

“…These markers help to evaluate the dynamics of bone resorption and formation in the osteoporotic bone. BTMs, such as bone alkaline phosphatase (bALP) and procollagen type I N propeptide (PINP), are used as biomarkers for bone ossification, while serum cross-linked C-telopeptides of type I collagen (bCTx) and urinary cross-linked N-telopeptides of type I collagen (NTx) for bone resorption [ 55 , 56 ]. Several endogenous factors, such as age, gender, diseases, ethnicity, and fractures exert an influence on the BTMs [ 57 ].…”