Use of Bone Turnover Markers in Clinical Osteoporosis Assessment in Women: Current Issues and Future Options

Abstract

Monitoring bone turnover of the adult and aging skeleton is essential for optimal treatment of bone metabolic diseases, such as postmenopausal osteoporosis. Diagnosis of osteoporosis is based solely on dual-emission x-ray absorptiometry-based measurements of bone mineral density. However, within the last 20 years, biochemical markers of bone turnover have been implemented to a larger degree, and especially within the field of drug development. Numerous clinical studies have underscored that the markers have promise in terms of predicting patients at high risk of losing bone, future fracture events and importantly also the fracture efficacy of drugs in development. Furthermore, while classical methods often require years to monitor the changes, the bone turnover markers do so within a shorter time span. The aims of this article are to provide an update on the different biochemical markers of bone turnover, and to give an overview of their applications in epidemiological and clinical research especially in women. The main emphasis will be on their utility in clinical trials testing the efficacy of drugs for the treatment of osteoporosis, and their ability to supplement bone mass measurements. Finally, recent evidence suggests that biochemical markers may provide information on bone age that may indirectly relate to bone quality, and this is discussed together with future possibilities for measuring bone quality using bone turnover markers. In summary, a more targeted use of biomarkers could assist in the identification of high-risk patients, the process of drug discovery and monitoring of the efficacy of osteoporosis treatment in clinical settings.

Tectorigenin inhibits RANKL‐induced osteoclastogenesis via suppression of NF‐κB signalling and decreases bone loss in ovariectomized C57BL/6

“…The reduction of oestrogen levels is related to the development of postmenopausal osteoporosis in female populations 5, 21. This study simulates menopause by removing the ovaries in female C57BL/6 mice, resulting in postmenopausal osteoporosis.…”

“…Therefore, to simulate the pharmacologic intervention after diagnosis of osteoporosis in clinical practice, we added tectorigenin into the medium after the appearance of osteoclasts to evaluate its therapeutic effect. Tartrate-resistant acid phosphatase staining showed less osteoclasts in tectorigenin-treated groups, which indicated that tectorigenin treatment had a therapeutic effect on RANKL-induced osteoclast differentiation in vitro.The reduction of oestrogen levels is related to the development of postmenopausal osteoporosis in female populations 5,21. This study simulates menopause by removing the ovaries in female C57BL/6 mice, resulting in postmenopausal osteoporosis.…”

Will Posttranslational Modifications of Brain Proteins Provide Novel Serological Markers for Dementias?

“…Furthermore, as illustrated by the β -CTX-I example, numerous parameters need to be investigated in detail in order to validate the relevance of a potential marker [80], and whether this approach or other approaches, that is, mass spectrometry-based analyses of CSF and/or plasma samples, will end up providing a fluid biomarker with a broader application remains to be seen. …”

Future detection and monitoring of diabetes may entail analysis of both β-cell function and volume: How markers of β-cell loss may assist

“…The use of this marker in the bone field has illustrated many of the benefits and a few of the challenges of this class of biomarkers [11]. …”

“…In addition it has been shown to respond to various anti-resorptive treatments, and to have predictive value for treatment efficacy on bone mineral density (BMD) [11]. Hence the β-CTX-I biomarker fits into all the BIPED categories [16].…”