Bone Turnover Markers in the Diagnosis and Monitoring of Metabolic Bone Disease
Open accessAbstract
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.
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The most often measured resorption markers in clinical practice for diagnosis of osteoporosis are ICTP, β-CTX, and NTX.
“The most often measured resorption markers in clinical practice for the diagnosis of osteoporosis are the C-terminal telopeptide of type I collagen (ICTP), β-CrossLaps (β-CTX), and the N-terminal telopeptide of type I collagen (NTX) [56].”
From Osteoporosis: Molecular Pathology, Diagnostics, and Therapeutics (2023) · cites this paper as [56]
The C- and N-Terminal Telopeptides section describes CTX and NTX as resorption markers used in clinical practice and identifies CrossLaps assays for CTX. But it says ICTP has limited clinical application and may respond more to skeletal metastases than to postmenopausal osteoporosis. The cited paper therefore does not support listing ICTP among the most often measured markers for osteoporosis diagnosis. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDegradation markers pyridinoline (Pir) and deoxypyridinoline (Dpir) are proxy measurements for osteoclast activity.
“Degradation markers, such as pyridinoline (Pir) and deoxypyridinoline (Dpir), are proxy measurements for osteoclast activity.”
From Osteoporosis: Molecular Pathology, Diagnostics, and Therapeutics (2023) · cites this paper as [56]
Experimental — accuracy not yet measured
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- Authors
- Greenblatt, M. B., Tsai, J. N., & Wein, M. N.
- Affiliations
- Weill Cornell Medicine (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Greenblatt, Matthew B
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-02-01
- Volume
- 63
- Issue
- 2
- Pages
- 464-474
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- PMC
- PMC5549920
- OpenAlex
- W2560774896
- Cited by
- 376
- References
- 97
- Citations by year
- 2026: 24 · 2025: 50 · 2024: 54 · 2023: 60 · 2022: 54 · 2021: 49 · 2020: 39 · 2019: 23 · 2018: 16 · 2017: 6 · 2014: 1
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Career Award for Medical Scientists from the Burroughs Wellcome Fund
- Office of the Director of the NIH (DP5OD021351)
- Junior Investigator Award from the Musculoskeletal Transplant Foundation
- NIAMS of the NIH (K23AR068447, K08AR067285)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Health Sciences › Medicine › Oncology › Bone health and treatments
- Keywords
- bone turnover markers, metabolic bone disease, osteoporosis, fracture risk, bone remodeling, osteoblasts, osteoclasts, pre-analytical variables, treatment monitoring, biomarkers
- MeSH terms
- Bone and Bones, Bone Diseases, Metabolic, Humans, Biomarkers, Bone Remodeling
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