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Use of bone turnover markers in the management of osteoporosis

Jain, Sumeet; Camacho, Pauline

Current Opinion in Endocrinology, Diabetes and Obesity: December 2018 - Volume 25 - Issue 6 - p 366–372
doi: 10.1097/MED.0000000000000446

Purpose of review Osteoporosis is a common public health problem that is often undertreated and underdiagnosed. The clinical management of osteoporosis is often reactionary to devastating fracture events. Bone turnover markers may improve the ease and rapidity at which osteoporosis is monitored and treated. Bone turnover markers are biochemical byproducts of bone formation or bone resorption. The clinical use of bone turnover markers is limited by significant preanalytical variability. Effective interpretation of bone turnover markers requires a detailed understanding of the variables that can affect their responses to osteoporosis treatment and monitoring.

Recent findings Progress is continuously being made on the standardization of bone turnover markers. The literature on the response of bone turnover markers to unique clinical situations is expanding. Data for evidence-based reference intervals for bone turnover markers has increased. Variables that affect the appropriate timing of lab draws like diurnal variation, postprandial status, exercise and alcohol use have been described. Studies examining the expected response of bone turnover markers to treatments of osteoporosis and other medications that affect bone health continue to increase.

Summary Bone turnover markers have clinical utility in the comprehensive evaluation of osteoporosis. When interpreted with caution and with a good understanding of their natural variability, bone turnover markers provide information that supplements osteoporosis management and provides useful clinical information about conditions that alter bone turnover.

Loyola University Medical Center, Maywood, Illinois, USA

Correspondence to Pauline Camacho, MD, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA. Tel: +1 708 216 0160; e-mail:

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