Bone Turnover Markers Add Prognostic Value but Preanalytic Pitfalls Persist
Bone turnover markers released during remodelling by osteoblasts and osteoclasts can supplement radiographic measures by providing fracture risk information and early detection of therapy response in osteoporosis. However, their clinical interpretation is complicated by numerous preanalytic variables including circadian rhythm, diet, and comorbid conditions. The review positions BTMs as a useful but carefully qualified adjunct in metabolic bone disease management.
The original study
Bone Turnover Markers in the Diagnosis and Monitoring of Metabolic Bone Disease.
- Authors
- Greenblatt MB, Tsai JN, Wein MN
- Journal
- Clinical chemistry
- Type
- Journal Article, Review
- PMID
- 27940448
Original abstract
BACKGROUND: Disorders of bone metabolism, most notably osteoporosis, are highly prevalent and predispose to fractures, causing high patient morbidity and mortality. Diagnosis and monitoring of bone metabolic defects can present a major challenge as these disorders are largely asymptomatic and radiographic measures of bone mass respond slowly to changes in bone physiology. CONTENT: Bone turnover markers (BTMs) are a series of protein or protein derivative biomarkers released during bone remodeling by osteoblasts or osteoclasts. BTMs can offer prognostic information on fracture risk that supplements radiographic measures of bone mass, but testing using BTMs has to take into account the large number of preanalytic factors and comorbid clinical conditions influencing BTM levels. BTMs respond rapidly to changes in bone physiology, therefore, they have utility in determining patient response to and compliance with therapies for osteoporosis. SUMMARY: BTMs are a useful adjunct for the diagnosis and therapeutic monitoring of bone metabolic disorders, but their use has to be tempered by the known limitations in their clinical utility and preanalytic variables complicating interpretation.