Bone turnover markers: Emerging tool in the management of osteoporosis

Abstract

Bone is a dynamic tissue which undergoes constant remodeling throughout the life span. Bone turnover is balanced with coupling of bone formation and resorption at various rates leading to continuous remodeling of bone. A study of bone turnover markers (BTMs) provides an insight of the dynamics of bone turnover in many metabolic bone disorders. An increase in bone turnover seen with aging and pathological states such as osteoporosis leads to deterioration of bone microarchitecture and thus contributes to an increase in the risk of fracture independent of low bone mineral density (BMD). These microarchitectural alterations affecting the bone quality can be assessed by BTMs and thus may serve as a complementary tool to BMD in the assessment of fracture risk. A systematic search of literature regarding BTMs was carried out using the PubMed database for the purpose of this review. Various reliable, rapid, and cost-effective automated assays of BTMs with good sensitivity are available for the management of osteoporosis. However, BTMs are subjected to various preanalytical and analytical variations necessitating strict sample collection and assays methods along with utilizing ethnicity-based reference standards for different populations. Estimation of fracture risk and monitoring the adherence and response to therapy, which is a challenge in a chronic, asymptomatic disease such as osteoporosis, are the most important applications of measuring BTMs. This review describes the physiology of bone remodeling, various conventional and novel BTMs, and BTM assays and their role in the assessment of fracture risk and monitoring response to treatment with antiresorptive or anabolic agents.

Potential Role of Lycopene in the Prevention of Postmenopausal Bone Loss: Evidence from Molecular to Clinical Studies

“…The resorption and reversal phases last for 2 weeks and 4–5 weeks, respectively. The formation phase is the longest and lasts approximately 4–6 months until the new bone is completely formed [ 30 , 37 , 38 ].…”

“…Bone mineral density (BMD), bone mineral content (BMC), and the quantity and quality of bone are the distinguishing factors between people with osteoporotic versus healthy bones [ 42 ]. The risk of osteoporosis is primarily evaluated through bone mineral density, which is predominantly measured by dual-energy X-ray absorptiometry (DEXA) scanning [ 38 ]. Other methods include magnetic resonance imaging (MRI), ultrasound, and microcomputed tomography [ 42 , 43 ].…”

Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis—A Survey

“…BTMs indicate the degree of deterioration of the bone microstructure and, may thus, independently of BMD, predict a person's fracture risk. Furthermore, BTMs can be used in conjunction with BMD to improve the accuracy of fracture risk assessment tools [464]. The use of BTMs in the osteoporotic risk analysis and in monitoring the efficacy of osteoporosis treatment is rapidly increasing [465][466][467][468].…”

“…FRAX integrates eight main CRFs (prior fragility fracture, parental hip fracture, smoking, systemic glucocorticoid use, excess alcohol intake, body mass index, rheumatoid arthritis, and other causes of secondary osteoporosis), which, in addition to age and sex, contribute to fracture risk analysis independently of BMD. FRAX does not consider risk factors such as BTM and those associated with falls, lower dietary calcium intake and Vitamin D deficiency [464], but has BMD as an optional input variable [165,469,470]. FRAX predictions can become more accurate when used in conjunction with, e.g., BMD and TBS [458].…”

A Case Report of Alendronate Treatment over 20 Years on Osteoporosis and Literature Review

“…Also, bone metabolic markers can be used for bone quality and fracture risk evaluation.Compared to BMD, they are more efficient in revealing the action of drugs through dynamic monitoring and improving patient compliance. Apart from this, they are free of X-ray radiation[27]. Bone metabolic markers are especially useful for patients suffering bone mass loss.…”