title: Clinical use of bone turnover markers to monitor pharmacologic fracture prevention therapy.
abstract: Monitoring of drug therapies to prevent fractures is controversial. Measurement of bone turnover markers has the potential to identify those with a suboptimal response to fracture prevention medication within a few months of its commencement. However, given the imprecision of currently commercially available assays of bone turnover markers, many individual persons who are “suboptimal medication responders” are likely to be misclassified as “adequate responders” or vice versa, depending on the cut point chosen to define suboptimal and adequate response. Before bone turnover markers can be recommended for routine use in clinical practice to monitor fracture prevention therapies, three advances are needed: 1) bone marker assays with better precision; 2) research establishing optimal cut points of bone marker levels to distinguish “suboptimal responders” from “adequate responders”; and 3) research establishing the incremental fracture reduction benefit from clinical interventions for “suboptimal responders” identified from bone marker measurements.
authors.affiliation: Park Nicollet Health Services, Division of Health Policyand Management, University of Minnesota, Minneapolis, MN, USA. scho0600@umn.edu
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
mesh_terms: D019386:Alendronate / Q000627:therapeutic use; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001862:Bone Resorption / Q000503:physiopathology; D002986:Clinical Trials as Topic; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008991:Monitoring, Physiologic / Q000379:methods; D058866:Osteoporotic Fractures / Q000097:blood / Q000517:prevention & control*; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D014945:Wound Healing / Q000502:physiology; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D020849:Raloxifene Hydrochloride; D000077211:Zoledronic Acid; D019386:Alendronate