J Bone Metab.  2019 Nov;26(4):271-277. 10.11005/jbm.2019.26.4.271.

Use of Bone Turnover Markers in Clinical Practice for the Management of Osteoporosis in Korea: From the Survey on the Prescription Pattern of Bone Turnover Markers

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea. sbhongmd@inha.ac.kr
  • 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
  • 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.


There has been interest in the clinical potential of bone turnover markers (BTMs) as tools both for assessing fracture risk and for monitoring treatment. However, the practical use of BTMs has been limited by their biological variability and difficulties in the interpretation of results. We investigated the current situation of application of BTMs by clinicians in Korea for the management of osteoporosis through a survey asking the patterns of BTMs prescription in clinical practice.
The survey was conducted online using the "google survey" by the BTM committee authorized by the Korean Society for Bone and Mineral Research.
Total 108 clinicians responded the survey. Most of the respondents prescribed BTMs (80.6%) when they prescribed anti-osteoporotic medications (AOMs). The most frequently prescribed bone resorption and formation markers were serum C-terminal telopeptide of type I collagen (90.7%) and osteocalcin (65.1%), respectively. BTMs were mostly prescribed before starting AOMs (90.8%) and used for the purpose of evaluating treatment response (74.4%). Treatment response and compliance to AOMs were evaluated according to the change of absolute value of BTMs (55.1%). The respondents complained difficulties in the interpretation of BTMs (33.3%), the choice of proper BTMs (17.2%), and the proper sample preparation and handling (13.8%).
In Korea, most of clinicians recognized the benefit of BTMs in the management of osteoporosis. However, there are limitations in the broad use of these markers in clinical practice. Therefore, a clear recommendation for BTM in Korea enhances their use in clinical practice.


Biomarkers; Bone remodeling; Osteoporosis

MeSH Terms

Bone Remodeling*
Bone Resorption
Collagen Type I
Surveys and Questionnaires
Collagen Type I


  • Fig. 1 Bone turnover markers (BTMs) usually prescribed by 87 Korean clinicians who prescribed BTMs in clinical practice. sOCN, serum osteocalcin; sBSALP, serum bone specific alkaline phosphatase; sP1CP, serum carboxyl-terminal propeptide of type 1 collagen; sP1NP, serum amino-terminal propeptide of type I procollagen; sCTX, serum C-terminal telopeptide of type I collagen; uCTX, urine C-terminal telopeptide of type I collagen; sNTX, serum N-terminal telopeptide of collagen type I; uNTX, urine N-terminal telopeptide of collagen type I; uPYD, urine free and total pyridinoline; uDPD, urine deoxypyridinoline.

  • Fig. 2 The time point when 87 Korean clinicians who prescribed bone turnover markers in clinical practice. AOMs, anti-osteoporotic medications.

  • Fig. 3 Difficulties in the prescription of bone turnover markers (BTMs) in 87 clinicians who prescribed BTMs in clinical practice.


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