Use of biochemical markers of bone turnover in the management of postmenopausal osteoporosis

Abstract

We currently have guidelines that allow us to use bone densitometry in the diagnosis and management of osteoporosis. The role of biochemical markers of bone turnover (BTMs) is less well defined. Serum and urine BTM patterns in treated and untreated osteoporotic patients have been studied to help us define their role. The aim of this review is to present data which helps elucidate the current role and limitation of BTMs in the management of osteoporosis. A search of the literature on BTMs was performed. References with keywords, such as bone turnover markers, biochemical markers, monitoring therapy and monitoring osteoporosis, were used. Literature describing the nature and limitation of currently available BTMs was reviewed. The clinical use and limitation of BTMs in assessing fracture risk reduction, bone mineral density (BMD) and response to therapy is available, whereas definitive guidelines have not yet been created. BTMs offer a potential non-invasive and reliable way of assessing skeletal activity, studying drug effects and response to therapies, assessing fracture risk and predicting other skeletal parameters, such as bone loss, BMD and bone mass. A 30%-70% reduction in bone resorption markers can be achieved with antiresorptive therapy, and 30%-50% increase in bone formation markers with anabolic therapy. We recommend that clinicians understand and incorporate the measurement of BTMs in the management of osteoporosis.