Biochemical markers in osteoporosis

Abstract

Biochemical indices of skeletal turnover have been widely used as a research tool to study the natural history of osteoporosis and to assess the pharmacodynamics of drug treatments. Their promise for the future depends on whether they can be used as an adjunct in the management of individual patients. Whereas indices of both bone resorption and formation provide little value in the diagnosis of individuals with osteoporosis, they have now been shown by prospective studies to provide estimates of skeletal loss, and indeed improve the prognostic accuracy of bone mineral density to estimate fracture risk. Biochmical indices of bone resorption have proved particularly useful in assessing interventions, particularly the inhibitors of bone resorption. They might therefore be used in individuals to assess responsivity or compliance with treatment. Precision errors of many of the numbers mean that they have relatively poor predictive value in individuals, but as the specificity and precision of assays increase, the predictive value is also likely to improve.