Parathyroids, bone and mineral metabolismBiochemical markers of bone turnover: clinical utilityRosen, Harold N.Author Information From the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Beth Israel Deaconess Medical Center, Department of Medicine, Divisions of Endocrinology and Metabolism and Bone and Mineral Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Correspondence to: Harold Rosen, MD, Division of Bone and Mineral Metabolism, ST 742, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA Tel: 617 667 1765; fax: 617 975 5392; e-mail [email protected] Current Opinion in Endocrinology & Diabetes: December 2003 - Volume 10 - Issue 6 - p 387-393 Buy Abstract Purpose Review of recent literature supporting the clinical applications of biochemical markers of bone turnover. Recent findings The most valuable markers of bone turnover are those that change substantially with antiresorptive treatment but have minimal spontaneous variability, such as serum CTX (amino-terminal propeptide of type I collagen) and PINP (peptide-bound C-telopeptide crosslinks of type I collagen). Markers are valuable in the monitoring of Paget disease, although newer markers have few advantages over the more economical total alkaline phosphatase. Although markers are elevated in patients with osseous metastases, there is little practical reason to use them in this setting. Markers of bone turnover are of limited utility in monitoring patients with arthritis, but new markers of cartilage turnover may be of much greater use. Markers of turnover such as bone-specific alkaline phosphatase are elevated in patients with high-turnover renal osteodystrophy, but it is not clear that bone-specific alkaline phosphatase is superior to serum parathyroid hormone in supporting this diagnosis. Markers of bone turnover probably have the greatest application to the selection of patients at high risk for bone loss and for monitoring patients receiving antiresorptive therapy for osteoporosis. Some published reports suggest that a decrease of 40 to 60% in markers of turnover with antiresorptive treatment is ideal. However, more research needs to be done to determine the ideal bone turnover target to indicate optimal treatment. Summary Biochemical markers of bone turnover have clinical utility in diverse settings, especially in the selection of patients for treatment with antiresorptive therapy and in assessing the adequacy of antiresorptive therapy in patients receiving treatment. © 2003 Lippincott Williams & Wilkins, Inc.