Chapter 30 - Bone remodeling markers and bone cancer

Abstract

Biochemical markers of bone turnover are widely used in clinical practice. In patients with malignant tumors, changes in bone turnover markers are associated with the occurrence, therapeutic response, and prognosis of secondary skeletal lesions. For example, markers of bone resorption are often elevated in patients with (usually widespread) metastatic bone disease. While such observations may point to a role of these markers in the diagnostic workup of cancer patients, the available evidence does not support the use of current bone markers in the early diagnosis of bone metastases. In contrast, most bone turnover markers respond to antiresorptive and antineoplastic therapies, and monitoring of disease progress and therapeutic response may be the true clinical domain of these indices in oncology. Thus, evidence from prospective trials in patients with established bone metastases suggests that the aim of bisphosphonate therapy should be the normalization of bone remodeling to optimize therapeutic outcomes. However, it remains to be seen whether the routine use of bone turnover markers in clinical settings is beneficial in regard to overall outcome in cancer patients. While most bone turnover markers have insufficient diagnostic or prognostic value to be used in isolation, their combination with other diagnostic techniques may improve clinical assessment of patients with bone-seeking cancers.