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The clinical utility of bone marker measurements in osteoporosis

Lookup NU author(s): Gill Wheater, Dr Mohsen Elshahaly, Dr Stephen Tuck, Dr Harish Datta, Professor Jaap Van Laar

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Osteoporosis is characterised by low bone mass and structural deterioration of bone tissue, resulting in increased fragility and susceptibility to fracture. Osteoporotic fractures are a significant cause of morbidity and mortality. Direct medical costs from such fractures in the UK are currently estimated at over two billion pounds per year, resulting in a substantial healthcare burden that is expected to rise exponentially due to increasing life expectancy. Currently bone mineral density is the WHO standard for diagnosis of osteoporosis, but poor sensitivity means that potential fractures will be missed if it is used alone. During the past decade considerable progress has been made in the identification and characterisation of specific biomarkers to aid the management of metabolic bone disease. Technological developments have greatly enhanced assay performance producing reliable, rapid, non-invasive cost effective assays with improved sensitivity and specificity. We now have a greater understanding of the need to regulate pre-analytical sample collection to minimise the effects of biological variation. However, bone turnover markers (BTMs) still have limited clinical utility. It is not routinely recommended to use BTMs to select those at risk of fractures, but baseline measurements of resorption markers are useful before commencement of anti-resorptive treatment and can be checked 3-6 months later to monitor response and adherence to treatment. Similarly, formation markers can be used to monitor bone forming agents. BTMs may also be useful when monitoring patients during treatment holidays and aid in the decision as to when therapy should be recommenced. Recent recommendations by the Bone Marker Standards Working Group propose to standardise research and include a specific marker of bone resorption (CTX) and bone formation (P1NP) in all future studies. It is hoped that improved research in turn will lead to optimised markers for the clinical management of osteoporosis and other bone diseases.


Publication metadata

Author(s): Wheater G, Elshahaly M, Tuck SP, Datta HK, van Laar JM

Publication type: Review

Publication status: Published

Journal: Journal of Translational Medicine

Year: 2013

Volume: 11

Online publication date: 29/08/2013

ISSN (electronic): 1479-5876

Publisher: BIOMED CENTRAL LTD

URL: http://dx.doi.org/10.1186/1479-5876-11-201

DOI: 10.1186/1479-5876-11-201


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