Biochemical markers of bone turnover: potential use in the investigation and management of postmenopausal osteoporosis.
BACKGROUND
The aim was to analyse data on the use of biochemical bone turnover markers (BTM) in postmenopausal osteoporosis.


METHODS
We carried out a comparative analysis of the most important papers concerning BTM in postmenopausal osteoporosis that have been published recently.


RESULTS
The BTM levels are influenced by several factors. They are moderately correlated with BMD and subsequent bone loss. Increased levels of bone resorption markers are associated with a higher risk of fracture. Changes in the BTM during the anti-osteoporotic treatment (including combination therapy) reflect the mechanisms of action of the drugs and help to establish their effective doses. Changes in the BTM during the anti-resorptive treatment are correlated with their anti-fracture efficacy.


CONCLUSIONS
Biological samples should be obtained in a standardised way. BTM cannot be used for prediction of the accelerated bone loss at the level of the individual. BTM help to detect postmenopausal women who are at high risk of fracture; however, adequate practical guidelines are lacking. BTM measurements taken during the anti-resorptive therapy help to identify non-compliers. They may improve adherence to the anti-resorptive therapy and the fall in the BTM levels that exceeds the predefined threshold improves patients' persistence with the treatment. There are no guidelines concerning the use of BTM in monitoring anti-osteoporotic therapy in postmenopausal women.
Szulc
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INSERM Research Unit 831, Hôpital Edouard Herriot, Lyon, France. pawel.szulc@inserm.fr
Delmas
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PD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001862:Bone Resorption / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology; D024042:Collagen Type I / Q000378:metabolism; D019317:Evidence-Based Medicine; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D015675:Osteocalcin / Q000378:metabolism; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology; D010446:Peptide Fragments / Q000378:metabolism; D012307:Risk Factors
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D010446:Peptide Fragments; D015675:Osteocalcin