Bone turnover markers: Understanding their value in clinical trials and clinical practice

R. Civitelli, R. Armamento-Villareal, N. Napoli

Research output: Contribution to journalArticle

Abstract

While bone mineral density (BMD) by dual-energy X-ray absorptiometry is the primary method of determining fracture risk, assessing bone turnover may add valuable information for the management of patients with low bone mass. Bone turnover markers (BTMs) are used in clinical trials where they can provide essential information on the biological efficacy of osteoporosis treatments. In such population-based studies, BTMs can predict fracture risk independent of BMD. When combined with BMD, they improve the fracture risk estimate above and beyond BMD alone in postmenopausal osteoporotic women. Since changes in bone turnover after the initiation of therapy with bone resorption inhibitors occur much more rapidly than changes in BMD, treatment efficacy could, in theory, be determined within weeks of using BTMs. However, such predictive value is limited by the large biological variability of these biochemical markers, even though newer automated methods have reduced their analytical variability. Consequently, widespread adoption as a means of predicting treatment efficacy in fracture prevention for individual patients cannot yet be recommended. BTMs may be useful for monitoring adherence to antiresorptive therapy and may aid in identifying patients for whom antiresorptive therapy is most appropriate. Thus, although BTMs are currently confined to clinical research applications, further improvement in assay precision may extend their diagnostic value in clinical settings.

Original languageEnglish
Pages (from-to)843-851
Number of pages9
JournalOsteoporosis International
Volume20
Issue number6
DOIs
Publication statusPublished - Jun 2009

Fingerprint

Bone Remodeling
Clinical Trials
Bone Density
Bone Density Conservation Agents
Information Management
Photon Absorptiometry
Osteoporosis
Therapeutics
Biomarkers
Bone and Bones
Research
Population

Keywords

  • Bone mineral density
  • Bone remodeling
  • Bone turnover markers
  • Fracture risk
  • Osteoporosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Bone turnover markers : Understanding their value in clinical trials and clinical practice. / Civitelli, R.; Armamento-Villareal, R.; Napoli, N.

In: Osteoporosis International, Vol. 20, No. 6, 06.2009, p. 843-851.

Research output: Contribution to journalArticle

Civitelli, R. ; Armamento-Villareal, R. ; Napoli, N. / Bone turnover markers : Understanding their value in clinical trials and clinical practice. In: Osteoporosis International. 2009 ; Vol. 20, No. 6. pp. 843-851.
@article{d3f39f851d6f46c485c6534cf72a4013,
title = "Bone turnover markers: Understanding their value in clinical trials and clinical practice",
abstract = "While bone mineral density (BMD) by dual-energy X-ray absorptiometry is the primary method of determining fracture risk, assessing bone turnover may add valuable information for the management of patients with low bone mass. Bone turnover markers (BTMs) are used in clinical trials where they can provide essential information on the biological efficacy of osteoporosis treatments. In such population-based studies, BTMs can predict fracture risk independent of BMD. When combined with BMD, they improve the fracture risk estimate above and beyond BMD alone in postmenopausal osteoporotic women. Since changes in bone turnover after the initiation of therapy with bone resorption inhibitors occur much more rapidly than changes in BMD, treatment efficacy could, in theory, be determined within weeks of using BTMs. However, such predictive value is limited by the large biological variability of these biochemical markers, even though newer automated methods have reduced their analytical variability. Consequently, widespread adoption as a means of predicting treatment efficacy in fracture prevention for individual patients cannot yet be recommended. BTMs may be useful for monitoring adherence to antiresorptive therapy and may aid in identifying patients for whom antiresorptive therapy is most appropriate. Thus, although BTMs are currently confined to clinical research applications, further improvement in assay precision may extend their diagnostic value in clinical settings.",
keywords = "Bone mineral density, Bone remodeling, Bone turnover markers, Fracture risk, Osteoporosis",
author = "R. Civitelli and R. Armamento-Villareal and N. Napoli",
year = "2009",
month = "6",
doi = "10.1007/s00198-009-0838-9",
language = "English",
volume = "20",
pages = "843--851",
journal = "Osteoporosis International",
issn = "0937-941X",
publisher = "Springer London",
number = "6",

}

TY - JOUR

T1 - Bone turnover markers

T2 - Understanding their value in clinical trials and clinical practice

AU - Civitelli, R.

AU - Armamento-Villareal, R.

AU - Napoli, N.

PY - 2009/6

Y1 - 2009/6

N2 - While bone mineral density (BMD) by dual-energy X-ray absorptiometry is the primary method of determining fracture risk, assessing bone turnover may add valuable information for the management of patients with low bone mass. Bone turnover markers (BTMs) are used in clinical trials where they can provide essential information on the biological efficacy of osteoporosis treatments. In such population-based studies, BTMs can predict fracture risk independent of BMD. When combined with BMD, they improve the fracture risk estimate above and beyond BMD alone in postmenopausal osteoporotic women. Since changes in bone turnover after the initiation of therapy with bone resorption inhibitors occur much more rapidly than changes in BMD, treatment efficacy could, in theory, be determined within weeks of using BTMs. However, such predictive value is limited by the large biological variability of these biochemical markers, even though newer automated methods have reduced their analytical variability. Consequently, widespread adoption as a means of predicting treatment efficacy in fracture prevention for individual patients cannot yet be recommended. BTMs may be useful for monitoring adherence to antiresorptive therapy and may aid in identifying patients for whom antiresorptive therapy is most appropriate. Thus, although BTMs are currently confined to clinical research applications, further improvement in assay precision may extend their diagnostic value in clinical settings.

AB - While bone mineral density (BMD) by dual-energy X-ray absorptiometry is the primary method of determining fracture risk, assessing bone turnover may add valuable information for the management of patients with low bone mass. Bone turnover markers (BTMs) are used in clinical trials where they can provide essential information on the biological efficacy of osteoporosis treatments. In such population-based studies, BTMs can predict fracture risk independent of BMD. When combined with BMD, they improve the fracture risk estimate above and beyond BMD alone in postmenopausal osteoporotic women. Since changes in bone turnover after the initiation of therapy with bone resorption inhibitors occur much more rapidly than changes in BMD, treatment efficacy could, in theory, be determined within weeks of using BTMs. However, such predictive value is limited by the large biological variability of these biochemical markers, even though newer automated methods have reduced their analytical variability. Consequently, widespread adoption as a means of predicting treatment efficacy in fracture prevention for individual patients cannot yet be recommended. BTMs may be useful for monitoring adherence to antiresorptive therapy and may aid in identifying patients for whom antiresorptive therapy is most appropriate. Thus, although BTMs are currently confined to clinical research applications, further improvement in assay precision may extend their diagnostic value in clinical settings.

KW - Bone mineral density

KW - Bone remodeling

KW - Bone turnover markers

KW - Fracture risk

KW - Osteoporosis

UR - http://www.scopus.com/inward/record.url?scp=67349103852&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67349103852&partnerID=8YFLogxK

U2 - 10.1007/s00198-009-0838-9

DO - 10.1007/s00198-009-0838-9

M3 - Article

C2 - 19190842

AN - SCOPUS:67349103852

VL - 20

SP - 843

EP - 851

JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

IS - 6

ER -