DIAGNOSIS OF ENDOCRINE DISEASE: Bone turnover markers: are they clinically useful?

Abstract

Bone turnover markers (BTMs) are useful in clinical practice as they are inexpensive, and they have proven useful for treatment monitoring and identification of poor adherence. BTMs cannot be used in individual patients for identifying accelerated bone loss or an increase in fracture risk or in deciding on the optimal therapy. They are useful for monitoring both anti-resorptive and anabolic treatment. Response can be defined as a result that exceeds an absolute target, or by a change greater than the least significant change; if such a response is not present, then poor compliance or secondary osteoporosis are likely causes. A baseline BTM measurement is not always made; in that case, a value of BTM on anti-resorptive treatment that is low or low normal or above the reference interval for anabolic therapy may be taken to indicate a satisfactory response. We provide an approach to using these bone turnover markers in clinical practice by describing algorithms for anti-resorptive and anabolic therapy and describing the changes we observe in the clinical practice setting.

Potassium Citrate Supplementation Decreases the Biochemical Markers of Bone Loss in a Group of Osteopenic Women: The Results of a Randomized, Double-Blind, Placebo-Controlled Pilot Study

“…The BTMs selected in this study cover different stages of bone remodeling. PINP reflects the production of type I collagen by OBs and the highest concentration is found during the proliferative phase; BAP is mainly expressed during matrix maturation; TRACP5b is related to the OC number while CTX is indicative of their activity [ 46 ]. In general, BTM levels reflect the increased BRU activity and correlate with the bone loss [ 32 ] and, therefore, they are considered a useful tool for assessing the response to anti-osteoporotic drugs.…”

A History of Pivotal Advances in Clinical Research into Bone and Mineral Diseases

“…(32) Bone turnover can now be assessed noninvasively because of the introduction of assays for markers that are specific to bone and have simple formats which can be automated. (33) The bone turnover markers reflect bone resorption and formation and so have proven useful in drug development in optimizing drug dose and schedule and understanding mechanism of action. (34) Procollagen 1 intact n-terminal propeptide (PINP), a marker of bone formation, and carboxy-terminal propeptide (CTX), a marker of resorption, have become the most widely used bone turnover markers.…”

Denosumab significantly improves lumbar spine bone mineral density more in treatment-naïve than in long-term bisphosphonate-treated patients

“…2 ). Previous studies have demonstrated that the BMD increases in response to most OP therapies were related to bone turnover marker levels at therapy commencement ( Kamimura et al, 2017 ; Miller et al, 2016 ; Nakamura et al, 2012 ; Eastell et al, 2018 ; Chen et al, 2005 ). Since the present investigation showed lower turnover markers in patients previously treated with BPs, smaller BMD percentage increases in this group are consistent with earlier studies ( Kamimura et al, 2017 ; Miller et al, 2016 ; Nakamura et al, 2012 ; Eastell et al, 2018 ; Chen et al, 2005 ).…”