J Bone Metab.  2019 Nov;26(4):213-224. 10.11005/jbm.2019.26.4.213.

Position Statement on the Use of Bone Turnover Markers for Osteoporosis Treatment

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
  • 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea. sbhongmd@inha.ac.kr
  • 3Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea.
  • 4Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
  • 6Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 7Division of Endocrinology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea.
  • 8Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 9Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

Current evidences continue to support the clinical application of bone turnover markers (BTMs) in the management of postmenopausal osteoporosis. The limitations of bone mineral density measured by dual energy X-ray absorptiomet especially emphasize the beneficial roles of BTMs, such as serum C-terminal telopeptide of type I collagen and serum procollagen type I N-propeptide, as monitoring tools to assess the responses to treatment. Therefore, the proper application and assessment of BTM in clinical practice is very important. However, their use in Korea is still insufficient. Therefore, the BTM committee has set up by the Korean Society for Bone and Mineral Research have been constituted and provided a position statement which will suggest on the clinical application of BTM for the management of postmenopausal osteoporosis in Korea.

Keyword

Bone remodeling; Osteoporosis; Republic of Korea

MeSH Terms

Bone Density
Bone Remodeling*
Collagen Type I
Female
Humans
Korea
Miners
Osteoporosis*
Osteoporosis, Postmenopausal
Republic of Korea
Collagen Type I

Figure

  • Fig. 1 The algorithm of bone turnover marker use in osteoporosis treatment. PINP, propeptide of type I collagen; BSALP, bone specific alkaline phosphatase; CTX-1, C-terminal telopeptide of type I collagen; NTX-1, N-terminal telopeptide of collagen type I; DPD, deoxypyridinoline; PYD, pyridinoline; BP, bisphosphonate; SERM, selective estrogen receptor modulator; LSC, least significant changes.


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Romosozumab in Postmenopausal Korean Women with Osteoporosis: A Randomized, Double-Blind, Placebo-Controlled Efficacy and Safety Study
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Endocrinol Metab. 2021;36(1):60-69.    doi: 10.3803/EnM.2020.848.

The Use of Bone-Turnover Markers in Asia-Pacific Populations
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Ann Lab Med. 2024;44(2):126-134.    doi: 10.3343/alm.2023.0214.


Reference

1. Peck WA, Burckhardt P, Christiansen C, et al. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993; 94:646–650.
Article
2. Weinstein RS. True strength. J Bone Miner Res. 2000; 15:621–625.
Article
3. Blake GM, Fogelman I. Role of dual-energy X-ray absorptiometry in the diagnosis and treatment of osteoporosis. J Clin Densitom. 2007; 10:102–110.
Article
4. Feng X, McDonald JM. Disorders of bone remodeling. Annu Rev Pathol. 2011; 6:121–145.
Article
5. Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res. 1996; 11:1531–1538.
Article
6. Garnero P, Sornay-Rendu E, Claustrat B, et al. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res. 2000; 15:1526–1536.
Article
7. Ross PD, Kress BC, Parson RE, et al. Serum bone alkaline phosphatase and calcaneus bone density predict fractures: a prospective study. Osteoporos Int. 2000; 11:76–82.
Article
8. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014; 25:2359–2381.
Article
9. Orimo H, Nakamura T, Hosoi T, et al. Japanese 2011 guidelines for prevention and treatment of osteoporosis--executive summary. Arch Osteoporos. 2012; 7:3–20.
Article
10. Vasikaran S, Eastell R, Bruyere O, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int. 2011; 22:391–420.
Article
11. Park SY, Ahn SH, Yoo JI, et al. Clinical application of bone turnover markers in osteoporosis in Korea. J Bone Metab. 2019; 26:19–24.
Article
12. Nishizawa Y, Ohta H, Miura M, et al. Guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis (2012 edition). J Bone Miner Metab. 2013; 31:1–15.
Article
13. Szulc P. The role of bone turnover markers in monitoring treatment in postmenopausal osteoporosis. Clin Biochem. 2012; 45:907–919.
Article
14. Szulc P, Naylor K, Hoyle NR, et al. Use of CTX-I and PINP as bone turnover markers: National Bone Health Alliance recommendations to standardize sample handling and patient preparation to reduce pre-analytical variability. Osteoporos Int. 2017; 28:2541–2556.
Article
15. Christgau S, Rosenquist C, Alexandersen P, et al. Clinical evaluation of the Serum CrossLaps One Step ELISA, a new assay measuring the serum concentration of bone-derived degradation products of type I collagen C-telopeptides. Clin Chem. 1998; 44:2290–2300.
Article
16. Garnero P, Borel O, Delmas PD. Evaluation of a fully automated serum assay for C-terminal cross-linking telopeptide of type I collagen in osteoporosis. Clin Chem. 2001; 47:694–702.
Article
17. Morovat A, Catchpole A, Meurisse A, et al. IDS iSYS automated intact procollagen-1-N-terminus pro-peptide assay: method evaluation and reference intervals in adults and children. Clin Chem Lab Med. 2013; 51:2009–2018.
Article
18. Qvist P, Christgau S, Pedersen BJ, et al. Circadian variation in the serum concentration of C-terminal telopeptide of type I collagen (serum CTx): effects of gender, age, menopausal status, posture, daylight, serum cortisol, and fasting. Bone. 2002; 31:57–61.
Article
19. Redmond J, Fulford AJ, Jarjou L, et al. Diurnal rhythms of bone turnover markers in three ethnic groups. J Clin Endocrinol Metab. 2016; 101:3222–3230.
Article
20. Clowes JA, Hannon RA, Yap TS, et al. Effect of feeding on bone turnover markers and its impact on biological variability of measurements. Bone. 2002; 30:886–890.
Article
21. Gass ML, Kagan R, Kohles JD, et al. Bone turnover marker profile in relation to the menstrual cycle of premenopausal healthy women. Menopause. 2008; 15:667–675.
Article
22. Bhattoa HP, Nagy E, More C, et al. Prevalence and seasonal variation of hypovitaminosis D and its relationship to bone metabolism in healthy Hungarian men over 50 years of age: the HunMen Study. Osteoporos Int. 2013; 24:179–186.
Article
23. Pasco JA, Henry MJ, Kotowicz MA, et al. Seasonal periodicity of serum vitamin D and parathyroid hormone, bone resorption, and fractures: the Geelong Osteoporosis Study. J Bone Miner Res. 2004; 19:752–758.
Article
24. Weiler R, Keen R, Wolman R. Changes in bone turnover markers during the close season in elite football (soccer) players. J Sci Med Sport. 2012; 15:255–258.
Article
25. Bae SJ, Kim BJ, Lim KH, et al. Efficacy of intravenously administered ibandronate in postmenopausal Korean women with insufficient response to orally administered bisphosphonates. J Bone Miner Metab. 2012; 30:588–595.
Article
26. Johnell O, Odén A, De Laet C, et al. Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int. 2002; 13:523–526.
Article
27. Vergnaud P, Garnero P, Meunier PJ, et al. Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women: the EPIDOS Study. J Clin Endocrinol Metab. 1997; 82:719–724.
Article
28. Garnero P, Cloos P, Sornay-Rendu E, et al. Type I collagen racemization and isomerization and the risk of fracture in postmenopausal women: the OFELY prospective study. J Bone Miner Res. 2002; 17:826–833.
Article
29. Gerdhem P, Ivaska KK, Alatalo SL, et al. Biochemical markers of bone metabolism and prediction of fracture in elderly women. J Bone Miner Res. 2004; 19:386–393.
Article
30. Marques EA, Gudnason V, Lang T, et al. Association of bone turnover markers with volumetric bone loss, periosteal apposition, and fracture risk in older men and women: the AGES-Reykjavik longitudinal study. Osteoporos Int. 2016; 27:3485–3494.
Article
31. Melton LJ 3rd, Crowson CS, O'Fallon WM, et al. Relative contributions of bone density, bone turnover, and clinical risk factors to long-term fracture prediction. J Bone Miner Res. 2003; 18:312–318.
Article
32. Leiper JM, Paterson KR, Lunan CB, et al. A comparison of biosynthetic human insulin with porcine insulin in the blood glucose control of diabetic pregnancy. Diabet Med. 1986; 3:49–51.
Article
33. Ulivieri FM, Piodi LP, Grossi E, et al. The role of carboxy-terminal cross-linking telopeptide of type I collagen, dual x-ray absorptiometry bone strain and Romberg test in a new osteoporotic fracture risk evaluation: A proposal from an observational study. PLoS One. 2018; 13:e0190477.
Article
34. Vasikaran S. Assessment of bone turnover in osteoporosis: harmonization of the total testing process. Clin Chem Lab Med. 2018; 56:1603–1607.
Article
35. Naylor KE, Jacques RM, Paggiosi M, et al. Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study. Osteoporos Int. 2016; 27:21–31.
Article
36. Black DM, Reid IR, Cauley JA, et al. The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res. 2015; 30:934–944.
Article
37. Miller PD, Pannacciulli N, Brown JP, et al. Denosumab or zoledronic acid in postmenopausal women with osteoporosis previously treated with oral bisphosphonates. J Clin Endocrinol Metab. 2016; 101:3163–3170.
Article
38. Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017; 5:513–523.
Article
39. Lamy O, Gonzalez-Rodriguez E, Stoll D, et al. Severe rebound-associated vertebral fractures after denosumab discontinuation: 9 clinical cases report. J Clin Endocrinol Metab. 2017; 102:354–358.
Article
40. Naylor KE, Jacques RM, Peel NF, et al. Response of bone turnover markers to raloxifene treatment in postmenopausal women with osteopenia. Osteoporos Int. 2016; 27:2585–2592.
Article
41. Finkelstein JS, Leder BZ, Burnett SM, et al. Effects of teriparatide, alendronate, or both on bone turnover in osteoporotic men. J Clin Endocrinol Metab. 2006; 91:2882–2887.
Article
42. Glover SJ, Eastell R, McCloskey EV, et al. Rapid and robust response of biochemical markers of bone formation to teriparatide therapy. Bone. 2009; 45:1053–1058.
Article
43. Eastell R, Krege JH, Chen P, et al. Development of an algorithm for using PINP to monitor treatment of patients with teriparatide. Curr Med Res Opin. 2006; 22:61–66.
Article
44. Shirley M. Abaloparatide: First global approval. Drugs. 2017; 77:1363–1368.
Article
45. Miller PD, Hattersley G, Riis BJ, et al. Effect of Abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: A randomized clinical trial. JAMA. 2016; 316:722–733.
Article
46. McClung MR, Grauer A, Boonen S, et al. Romosozumab in postmenopausal women with low bone mineral density. N Engl J Med. 2014; 370:412–420.
Article
47. Delmas PD, Vrijens B, Eastell R, et al. Effect of monitoring bone turnover markers on persistence with risedronate treatment of postmenopausal osteoporosis. J Clin Endocrinol Metab. 2007; 92:1296–1304.
Article
48. Diez-Perez A, Naylor KE, Abrahamsen B, et al. International osteoporosis foundation and European calcified tissue society working group. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporos Int. 2017; 28:767–774.
Article
49. Sun V, Raz DJ, Erhunmwunsee L, et al. Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention. Contemp Clin Trials. 2019; 83:88–96.
Article
50. Bindon B, Adams W, Balasubramanian N, et al. Osteoporotic fractures during bisphosphonate drug holiday. Endocr Pract. 2018; 24:163–169.
Article
51. Roberts J, Castro C, Moore AE, et al. Changes in bone mineral density and bone turnover in patients on ‘drug holiday’ following bisphosphonate therapy: real-life clinic setting. Clin Endocrinol (Oxf). 2016; 84:509–515.
Article
52. McClung M, Harris ST, Miller PD, et al. Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med. 2013; 126:13–20.
Article
53. Bonnick SL, Shulman L. Monitoring osteoporosis therapy: bone mineral density, bone turnover markers, or both? Am J Med. 2006; 119:S25–S31.
Article
54. Wasnich RD, Miller PD. Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab. 2000; 85:231–236.
Article
55. Cummings SR, Karpf DB, Harris F, et al. Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med. 2002; 112:281–289.
Article
56. Camacho PM, Petak SM, Binkley N, et al. American association of clinical endocrinologists and American college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis - 2016. Endocr Pract. 2016; 22:1–42.
Article
57. Lee SH, Gong HS, Kim TH, et al. Position statement: Drug holiday in osteoporosis treatment with bisphosphonates in South Korea. J Bone Metab. 2015; 22:167–174.
Article
58. Anagnostis P, Stevenson JC. Bisphosphonate drug holidays- when, why and for how long? Climacteric. 2015; 18 Suppl 2:32–38.
59. Peisker A, Raschke GF, Fahmy MD, et al. Cross-sectional study of four serological bone turnover markers for the risk assessment of medication-related osteonecrosis of the jaw. J Craniofac Surg. 2018; 29:e137–e140.
Article
60. Giusti A, Hamdy NA, Papapoulos SE. Atypical fractures of the femur and bisphosphonate therapy: A systematic review of case/case series studies. Bone. 2010; 47:169–180.
Article
61. Friedlander AH, Chang TI, Hazboun RC, et al. High C-terminal cross-linking telopeptide levels are associated with a minimal risk of osteonecrosis of the jaws in patients taking oral bisphosphonates and having exodontia. J Oral Maxillofac Surg. 2015; 73:1735–1740.
Article
62. Lee JJ, Cheng SJ, Wang JJ, et al. Factors predicting the prognosis of oral alendronate-related osteonecrosis of the jaws: a 4-year cohort study. Head Neck. 2013; 35:1787–1795.
Article
63. Lee CY, Suzuki JB. CTX biochemical marker of bone metabolism. Is it a reliable predictor of bisphosphonate-associated osteonecrosis of the jaws after surgery? Part II: a prospective clinical study. Implant Dent. 2010; 19:29–38.
Article
64. Lee CY, Suzuki JB. CTX biochemical marker of bone metabolism. Is it a reliable predictor of bisphosphonate-associated osteonecrosis of the jaws after surgery? Part I: biological concepts with a review of the literature. Implant Dent. 2009; 18:492–500.
Article
65. Iizuka Y, Iizuka H, Kaneko T, et al. Bone turnover markers and the factors associated with atypical femur fractures among Japanese patients. Injury. 2016; 47:2484–2489.
Article
66. Chiang C. The use of bone turnover markers in chronic kidney disease-mineral and bone disorders. Nephrology (Carlton). 2017; 22 Suppl 2:11–13.
Article
67. Ueda M, Inaba M, Okuno S, et al. Clinical usefulness of the serum N-terminal propeptide of type I collagen as a marker of bone formation in hemodialysis patients. Am J Kidney Dis. 2002; 40:802–809.
Article
68. Cavalier E, Delanaye P, Moranne O. Variability of new bone mineral metabolism markers in patients treated with maintenance hemodialysis: implications for clinical decision making. Am J Kidney Dis. 2013; 61:847–848.
Article
69. Isakova T, Nickolas TL, Denburg M, et al. KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Am J Kidney Dis. 2017; 70:737–751.
Article
70. Delanaye P, Souberbielle JC, Lafage-Proust MH, et al. Can we use circulating biomarkers to monitor bone turnover in CKD haemodialysis patients? Hypotheses and facts. Nephrol Dial Transplant. 2014; 29:997–1004.
Article
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