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Practical Considerations for the Clinical Application of Bone Turnover Markers in Osteoporosis

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Abstract

Bone turnover markers (BTMs) are released during the bone remodelling cycle and are measurable in blood or urine, reflecting bone remodelling rate. They have been useful in elucidating the pharmacodynamics and effectiveness of osteoporosis medication in clinical trials and are increasingly used in routine clinical management of osteoporosis, especially for monitoring therapy, in addition to their use in other metabolic bone disease such as Paget’s disease of bone and osteomalacia. Serum β isomerised C-terminal telopeptide of type I collagen and pro-collagen I N-terminal propeptide have been designated as reference BTMs for use in osteoporosis. In addition, bone-specific isoenzyme of alkaline phosphatase (B-ALP) secreted by osteoblasts and tartrate-resistant acid phosphatase 5b (TRACP-5b) secreted by osteoclasts are also found to be specific markers of bone formation and resorption, respectively. The concentrations of the latter enzymes in blood measured by immunoassay provide reliable measures of bone turnover even in the presence of renal failure. B-ALP is recommended for use in the assessment of renal bone disease of chronic kidney disease, and TRACP-5b shows promise as a marker of bone resorption in that condition. BTMs in blood do not suffer from biological variation to the same extent as the older BTMs that were measured in urine. Appropriate patient preparation and sample handling are important in obtaining accurate measures of BTMs for clinical use. Reference change values and treatment targets have been determined for the reference BTMs for their use in monitoring osteoporosis treatment. Further ongoing studies will enhance their clinical applications.

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Authors and Affiliations

  1. PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia

    Samuel D. Vasikaran

  2. Faculty of Pharmaceutical Sciences, Hokuriku University/Hokuriku University Healthy Aging Research Group, 3 Ho Kanagawa-machi, Kanazawa City, Ishikawa, 9201181, Japan

    Masakazu Miura

  3. Department of Clinical Biochemistry and Bone Metabolism, Klatovska Hospital, Klatovy, Czech Republic

    Richard Pikner

  4. Department of Clinical Biochemistry and Haematology, Faculty of Medicine Pilsen, Charles University Prague, Pilsen, Czech Republic

    Richard Pikner

  5. Faculty of Health Care Studies, University of West Bohemia, Pilsen, Czech Republic

    Richard Pikner

  6. Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

    Harjit P. Bhattoa

  7. Department of Clinical Chemistry, University of Liège, CHU de Liège, Domaine du Sart-Tilman, 4000, Liège, Belgium

    Etienne Cavalier

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EC is a consultant for Diasorin, IDS, Fujirebio, Menarini and Nittobo. MM is a consulatant for Beckmann-Coulter Japan and Nittobo Medical. RP is a member of advisory board for Amgen Czech Republic and has received a speaker honorarium from Amgen, Takeda, Roche, DiaSorin, Abbott and Beckmann-Coulter. HB and SV have no conflicts to declare.

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Vasikaran, S.D., Miura, M., Pikner, R. et al. Practical Considerations for the Clinical Application of Bone Turnover Markers in Osteoporosis. Calcif Tissue Int 112, 148–157 (2023). https://doi.org/10.1007/s00223-021-00930-4

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