Ann Lab Med.  2012 Mar;32(2):105-112. 10.3343/alm.2012.32.2.105.

Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis

• Lee J
• Vasikaran

• KMID: 1245249
• DOI: http://doi.org/10.3343/alm.2012.32.2.105

Abstract

Osteoporosis is a major health problem worldwide, and is projected to increase exponentially due to the aging of the population. The absolute fracture risk in individual subjects is calculated by the use of algorithms which include bone mineral density (BMD), age, gender, history of prior fracture and other risk factors. This review describes the laboratory investigations into osteoporosis which include serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone. Parathyroid hormone (PTH) is measured in patients with abnormal serum calcium to determine its cause. Other laboratory investigations such as thyroid function testing, screening for multiple myeloma, and screening for Cushing's syndrome, are performed if indicated. Measurement of bone turnover markers (BTMs) is currently not included in algorithms for fracture risk calculations due to the lack of data. However, BTMs may be useful for monitoring osteoporosis treatment. Further studies of the reference BTMs serum carboxy terminal telopeptide of collagen type I (s-CTX) and serum procollagen type I N-terminal propeptide (s-PINP) in fracture risk prediction and in monitoring various treatments for osteoporosis may help expedite their inclusion in routine clinical practice.

Keyword

Osteoporosis; Bisphosphonates; Bone turnover markers; Fracture risk; Monitoring treatment

MeSH Terms

Algorithms
Biological Markers/*blood
Clinical Laboratory Techniques
Collagen Type I/blood
Fractures, Bone/prevention & control
Humans
Osteoporosis/*diagnosis
Peptide Fragments/blood
Peptides/blood
Procollagen/blood

Figure

• 

  Fig. 1 The direction and magnitude of changes in a marker of bone resorption (serum CTX) and a marker of formation (serum PINP) in response to treatment with oral alendronate therapy [Drawn based on reference 54].Abbreviations: BTM, bone turnover marker; CTX, carboxy terminal telopeptide of collagen type I; PINP, procollagen type I N-terminal propeptide.

• 

  Fig. 2 The direction and magnitude of changes in a marker of bone resorption (urine NTX) and a marker of formation (serum PINP) in response to treatment with daily teriparatide injections [Drawn based on reference 55].Abbreviations: BTM, bone turnover marker; NTX, cross-linked N-telopeptides of type I collagen; PINP, procollagen type I N-terminal propeptide.

• 

  Fig. 3 An algorithm for the use of bone turnover markers (BTMs) in the monitoring of osteoporosis treatment [Based on references 58 and 63].

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