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Use of bone turnover markers in postmenopausal osteoporosis
Abstract
Bone turnover comprises two processes: the removal of old bone (resorption) and the laying down of new bone (formation). N-terminal propeptide of type I procollagen (PINP) and C-telopeptide of type I collagen (CTX-I) are markers of bone formation and resorption, respectively, that are recommended for clinical use. Bone turnover markers can be measured on several occasions in one individual with good precision. However, these markers are subject to several sources of variability, including feeding (resorption decreases) and recent fracture (all markers increase for several months). Bone turnover markers are not used for diagnosis of osteoporosis and do not improve prediction of bone loss or fracture within an individual. In untreated women, very high bone turnover marker concentrations suggest secondary causes of high bone turnover (eg, bone metastases or multiple myeloma). In people with osteoporosis, bone turnover markers might be useful to assess the response to anabolic and antiresorptive therapies, to assess compliance to therapy, or to indicate possible secondary osteoporosis. Much remains to be learnt about how bone turnover markers can be used to monitor the effect of stopping bisphosphonate therapy (eg, to identify a threshold above which restarting therapy should be considered). More studies are needed to investigate the use of bone turnover markers for assessment of the bone safety of new medications.
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“International consensus guidelines recommend assessment of two BTMs: procollagen type I N-terminal propeptide (PINP) (produced by osteoblasts during bone formation), and C-terminal cross-linking telopeptide of type I collagen (CTX) (released by osteoclasts during bone resorption) (8, 9).”
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Metadata
- Authors
- Eastell, R., & Szulc, P.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Eastell, Richard
- ORCID
- Eastell, Richard
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 5
- Issue
- 11
- Pages
- 908-923
- ISSN
- 2213-8587 (ISSN-L)
- OpenAlex
- W2733907025
- Cited by
- 594
- References
- 168
- Citations by year
- 2026: 62 · 2025: 94 · 2024: 89 · 2023: 82 · 2022: 92 · 2021: 75 · 2020: 47 · 2019: 32 · 2018: 18 · 2017: 3
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0513-10073)
- Medical Research Council (MR/K006312/1, MR/P020941/1)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Oncology › Bone health and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- bone turnover markers, postmenopausal osteoporosis, bone resorption, bone formation, P1NP, C-terminal telopeptide of type I collagen, secondary osteoporosis, fracture risk prediction
- MeSH terms
- Diphosphonates, Humans, Biomarkers, Bone Density, Osteoporosis, Postmenopausal, Bone Remodeling, Fracture Healing, Bone Density Conservation Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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