BoneKEy-Osteovision | Perspective
Biochemical markers of bone turnover and osteoporosis management
Marius E Kraenzlin
DOI:10.1138/20070266
Abstract
Osteoporosis is defined as a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue, both of which are related to abnormalities of bone turnover. Bone mass can be assessed by measuring bone mineral density (BMD) using dual X-ray absorptiometry (DXA) and there is a large body of evidence suggesting that low BMD is an important determinant of fracture risk. However, BMD measurement is not the only determinant of fracture risk. Increased bone resorption as evaluated by specific biochemical markers has been shown to be associated with an increased risk of hip, spine and non-vertebral fractures independently of BMD. The combination of bone mass measurement and the assessment of bone turnover by biochemical markers is thus helpful in the assessment of osteoporotic fracture risk. Repeated measurement of biochemical markers during treatment appears to improve the management of osteoporotic patients. The decrease in bone turnover markers during antiresorptive treatment is inversely related to the subsequent increase in BMD. Furthermore, several studies have shown that short-term reductions in bone turnover were associated with a reduction in vertebral and/or non-vertebral fracture risk in women treated with antiresorptive agents. Preliminary data also suggest that serial bone marker measurements could be useful in identifying skeletal responders to anabolic therapy with PTH.
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