title: Bone turnover markers for osteoporotic status assessment? A systematic review of their diagnosis value at baseline in osteoporosis.
abstract: OBJECTIVE
  Osteoporosis diagnosis is based on bone mineral density (BMD) but bone remodeling is also a crucial issue. It can be assessed by bone turnover markers (BTMs). Their interest for the positive and etiological diagnosis of osteoporosis at baseline, and their predictive value for past asymptomatic vertebral fractures, were evaluated by a systematic review of the literature.
  
  
  METHODS
  Medline database was searched to identify all published reports analyzing BTMs and BMD or fractures. We conducted meta-analyses on BTMs levels according to osteoporotic status using random effects models.
  
  
  RESULTS
  Moderate and negative correlations were found, mainly in postmenopausal women, between BTMs and BMD, especially with bone alkaline phosphatase (bone ALP), osteocalcin, serum C-terminal and urine N-terminal crosslinking telopeptides of type I collagen (sCTX and uNTX). Bone ALP and sCTX levels are higher in osteoporotic patients compared to controls. High levels of bone ALP in primary hyperparathyroidism and low levels of osteocalcin in endogenous hypercorticism are the most relevant data reported in endocrine diseases associated with osteoporosis. High levels of BTMs, especially osteocalcin, bone ALP or sCTX, may be associated with prevalent vertebral fractures.
  
  
  CONCLUSIONS
  The diagnosis value of BTMs at baseline in osteoporosis is very low. The interest of BTMs for the etiological diagnostic of secondary osteoporosis has not been demonstrated. Data are lacking to address the interest of BTMs assessment to screen for vertebral fractures in asymptomatic patients with high risk factors of fractures.
authors: Department of Rheumatology, Roger Salengro Hospital, CHRU de Lille, University Lille Nord de France, 59037 Lille cedex, France. ebiver@yahoo.fr
authors: Emmanuel
authors: E
authors: Biver
authors: Florence
authors: F
authors: Chopin
authors: Guillaume
authors: G
authors: Coiffier
authors: Thomas Funck
authors: TF
authors: Brentano
authors: Béatrice
authors: B
authors: Bouvard
authors: Patrick
authors: P
authors: Garnero
authors: Bernard
authors: B
authors: Cortet
mesh_terms: D000469:Alkaline Phosphatase / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D015519:Bone Density; D016723:Bone Remodeling / Q000502:physiology*; D024042:Collagen Type I / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008593:Menopause; D015201:Meta-Analysis as Topic; D015675:Osteocalcin / Q000378:metabolism; D010024:Osteoporosis / Q000175:diagnosis* / Q000378:metabolism; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000378:metabolism; D010455:Peptides / Q000097:blood / Q000652:urine; D011237:Predictive Value of Tests
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D000469:Alkaline Phosphatase