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Abstract
Biochemical markers of bone turnover (bone-turnover markers) are released during bone formation or resorption and can be measured in blood and/or urine. The concentration of bone-turnover markers in serum or urine reflect bone remodeling activity and can potentially be used as surrogate markers of the rate of bone formation or bone resorption. While the diagnosis of osteoporosis is based on bone mineral density (BMD), the absolute fracture risk for a particular BMD measurement varies several fold depending on age and is also influenced by other clinical risk factors. The measurement of bone-turnover markers may be of additional value to BMD and clinical risk factors in fracture risk assessment by improving the sensitivity and specificity of prediction of future fractures. In clinical practice, bone-turnover markers may help make cost-effective treatment decisions in patients with borderline absolute risk. BMD changes following treatment cannot be detected with confidence for 12–24 months due to measurement imprecision. Bone-turnover markers, which show an early response following treatment, may be useful for monitoring therapy, identifying non-compliance and non-responders, and predicting early response to therapy. This review concludes by identifying the need for internationally agreed-upon standards for bone resorption and formation.
| Abbreviations and Glossary | ||
| B-ALP | = | bone-specific alkaline phosphatase |
| BMD | = | bone mineral density |
| BRU | = | bone-remodeling unit |
| CI | = | confidence interval |
| CTX | = | C-terminal cross-linking telopeptide of type I collagen |
| DOES | = | Dubbo Osteoporosis Epidemiology Study |
| DPD | = | deoxypyridinoline |
| DXA | = | dual-energy X-ray absorptiometry |
| EPIDOS | = | Epidemiology of Osteoporosis Study |
| ELISA | = | enzyme-linked immunosorbent assay |
| FIT | = | Fracture Intervention Trial |
| FLEX | = | Fracture Intervention Trial Long-term Extension |
| HPLC | = | high-performance liquid chromatography |
| ICTP | = | C-terminal cross-linking telopeptide of type I collagen generated by matrix metalloproteinases |
| IOF | = | International Osteoporosis Foundation |
| NAMS | = | North American Menopause Society |
| NHANES | = | National Health and Nutrition Examination Surveys |
| NTX | = | N-terminal cross-linking telopeptide of type I collagen |
| OPG | = | osteoprotegerin |
| OR | = | odds ratio |
| PINP | = | procollagen type I N propeptide |
| PICP | = | procollagen type I C propeptide |
| RANK | = | receptor activator of NF-kappaB |
| RANKL | = | receptor activator of NF-kappaB ligand |
| RIA | = | radioimmunoassay |
| SD | = | standard deviations |
| SOTI | = | Spinal Osteoporosis Therapeutic Intervention |
| TNF | = | tumor necrosis factor |
| TRACP | = | tartrate resistant acid phosphatase isoenzyme 5b |
| T score | = | the number of standard deviations from young normal person mean |
| UcOC | = | undercarboxylated osteocalcin |
| WHO | = | World Health Organization. |
| Abbreviations and Glossary | ||
| B-ALP | = | bone-specific alkaline phosphatase |
| BMD | = | bone mineral density |
| BRU | = | bone-remodeling unit |
| CI | = | confidence interval |
| CTX | = | C-terminal cross-linking telopeptide of type I collagen |
| DOES | = | Dubbo Osteoporosis Epidemiology Study |
| DPD | = | deoxypyridinoline |
| DXA | = | dual-energy X-ray absorptiometry |
| EPIDOS | = | Epidemiology of Osteoporosis Study |
| ELISA | = | enzyme-linked immunosorbent assay |
| FIT | = | Fracture Intervention Trial |
| FLEX | = | Fracture Intervention Trial Long-term Extension |
| HPLC | = | high-performance liquid chromatography |
| ICTP | = | C-terminal cross-linking telopeptide of type I collagen generated by matrix metalloproteinases |
| IOF | = | International Osteoporosis Foundation |
| NAMS | = | North American Menopause Society |
| NHANES | = | National Health and Nutrition Examination Surveys |
| NTX | = | N-terminal cross-linking telopeptide of type I collagen |
| OPG | = | osteoprotegerin |
| OR | = | odds ratio |
| PINP | = | procollagen type I N propeptide |
| PICP | = | procollagen type I C propeptide |
| RANK | = | receptor activator of NF-kappaB |
| RANKL | = | receptor activator of NF-kappaB ligand |
| RIA | = | radioimmunoassay |
| SD | = | standard deviations |
| SOTI | = | Spinal Osteoporosis Therapeutic Intervention |
| TNF | = | tumor necrosis factor |
| TRACP | = | tartrate resistant acid phosphatase isoenzyme 5b |
| T score | = | the number of standard deviations from young normal person mean |
| UcOC | = | undercarboxylated osteocalcin |
| WHO | = | World Health Organization. |