Bone Turnover Biochemical Markers

With estimates that one out of two white women in North America will suffer from an osteoporotic fracture sometime in their life, prevention of osteoporosis should be a major health objective for all women (and men). In addition, especially in post-menopausal women it is useful to predict the rate of bone loss and to further monitor how bone therapies are assisting over time.

Biochemical markers for bone turnover have improved over the last few years (1) and may help with prediction of rate of bone loss. Serum bone alkaline phosphatase, total osteocalcin and procollagen type 1 N-terminal propetide assays are best markers for bone formation (1). N- and C-terminal crosslinked telopeptides in urine and C-terminal telopeptides in serum are sensitive for bone resorption (1). Deoxypiridinoline in urine is another measurement of bone resorption, primarily useful during treatment (2).

Monitoring these biochemical markers can be useful for predicting rate of bone loss thereby can be supportive of recognizing osteoporosis or how effective antiresorptive or hormone-replacement therapies are on a patient. Depending on the rate status, a clinician can decide what therapies are most useful and make adjustments as seen fit.

A disadvantage is that biomarkers may not be as specific as needed to adequately detect rates of bone turnover, because any significant increase in resorption or formation results in increases in all biochemical markers (3). The markers are also not indicative of any certain disease, only reflecting on bone metabolism despite reason for changes (3).

Reference List

1. Eastell R, Hannon RA. Biomarkers of bone health and osteoporosis risk. Proc Nutr Soc 2008;67:157-62.
2. Kitatani K, Nakatsuka K, Naka H, Miki T, Morii H, Nishizawa Y. Clinical usefulness of measurements of urinary deoxypyridinoline (DPD) in patients with postmenopausal osteoporosis receiving intermittent cyclical etidronate: advantage of free form of DPD over total DPD in predicting treatment efficacy. J Bone Miner Metab 2003;21:217-24.
3. Srivastava AK, Vliet EL, Lewiecki ML, Abdelmalek A, Gluck O, Baylink DJ. Clinical Use of Serum and Urine Bone Markers in the Management of Osteoporosis [Abstract and Introduction]. Curr Med Res Opin 2005;21(7):1015-1026. Available at: Accessed on 22 Jan 2010.

Published by David Despain, MS, CFS

David is a science and health writer living on Long Island, New York. He's written for a variety of publications including Scientific American, Outside Online, the American Society for Nutrition's (ASN) Nutrition Notes Daily, and Institute of Food Technologists' (IFT) Food Technology magazine and Live! blog. He's also covered new findings reported at scientific meetings including Experimental Biology, AAAS, AOCS, CASW, Sigma Xi, IFT, and others on his personal blog "Evolving Health." David is also an active member of organizations including the National Association of Science Writers (NASW), the American Association for the Advancement of Science (AAAS), the American Society for Nutrition, the Institute of Food Technologists, and the National Audubon Society. David has a master's degree in human nutrition from the University of Bridgeport, and a bachelor's degree in English from University of Illinois at Springfield. He also earned his Certified Food Scientist credential from the Institute of Food Technologists.

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