The Use of Bone-Turnover Markers in Asia-Pacific Populations

Abstract

Bone-turnover marker (BTM) measurements in the blood or urine reflect the bone-remodeling rate and may be useful for studying and clinically managing metabolic bone diseases. Substantial evidence supporting the diagnostic use of BTMs has accumulated in recent years, together with the publication of several guidelines. Most clinical trials and observational and reference-interval studies have been performed in the Northern Hemisphere and have mainly involved Caucasian populations. This review focuses on the available data for populations from the Asia-Pacific region and offers guidance for using BTMs as diagnostic biomarkers in these populations. The procollagen I N-terminal propeptide and β-isomerized C-terminal telopeptide of type-I collagen (measured in plasma) are reference BTMs used for investigating osteoporosis in clinical settings. Premenopausal reference intervals (established for use with Asia-Pacific populations) and reference change values and treatment targets (used to monitor osteoporosis treatment) help guide the management of osteoporosis. Measuring BTMs that are not affected by renal failure, such as the bone-specific isoenzyme alkaline phosphatase and tartrate-resistant acid phosphatase 5b, may be advantageous for patients with advanced chronic kidney disease. Further studies of the use of BTMs in individuals with metabolic bone disease, coupled with the harmonization of commercial assays to provide equivalent results, will further enhance their clinical applications.

Insight into the potential of bone turnover biomarkers: integration in the management of osteoporosis and chronic kidney disease-associated osteoporosis

“…Regarding their clinical utility in the diagnosis of postmenopausal osteoporosis and the prediction of bone loss and fractures in individuals, BTMs have limited value [1 ▪▪ ,13,14]. In absence of fracture, the diagnosis of osteoporosis relies on a BMD T-score below −2.5 at the hip or spine or the presence of a fragility fracture.…”

“…In absence of fracture, the diagnosis of osteoporosis relies on a BMD T-score below −2.5 at the hip or spine or the presence of a fragility fracture. However, most patients with postmenopausal osteoporosis have PINP values in the upper portion of the reference range and the presence of a very high BTM value (more than one standard deviation above the upper reference limit) could suggest the need to investigate for a secondary cause for osteoporosis [6,7,14].…”

“…Ivaska et al [10] showed that β-CTX-I and TRACP-5b are predictive of short-term fracture in an elderly female population, whereas BTMs appear to be less valuable than other accumulated risk factors in the long term or after age 80. However, stronger evidence is still needed to determine their interaction with other risk factors and thus their contribution in risk assessment [14,17]. Hence, BTMs are not currently used as an independent tool without concomitant assessment of BMD, albeit they may have promising application prospects for fracture prediction [10,16].…”

“…Categorizing patients according to their pretreatment bone turnover status (high or low) based on their baseline BTMs measurements could theoretically provide clinicians with useful information to select the most appropriate pharmacological treatment (antiresorptive therapies for patients with increased BTMs and anabolic therapies for patients with low bone turnover) [14]. The Copenhagen BTM study investigated the ability of baseline levels of β-CTX-I and PINP to predict the response of osteoporosis patients to antiresorptive treatment based on the change in BMD.…”

“…The clinically silent nature of the osteoporotic disease combined with the need for long-term treatment to maintain the efficacy of therapy without tangible results that are perceptible to the patient, can lead to nonadherence, which can significantly hinder the effectiveness of treatment [6,7,14]. Moreover, the slow detection of BMD change by dual-energy X-ray absorptiometry (DXA) after initiation of antiresorptive therapy – repeat measurement is not indicated before 1–3 years – have highlighted the need for surrogate markers to assess treatment efficacy and patient adherence [19 ▪ ].…”