Endocrine Abstracts

Bone turnover markers reflect the work of the osteoblast and the osteoclast. They can be measured in blood or urine and allow for an inexpensive and non-invasive way to study bone metabolism. They have been evaluated for their use in predicting risk of fracture, accelerated bone loss or the presence of secondary osteoporosis, but for all these uses they are not yet established. They are useful in monitoring the response to treatment of osteoporosis, especially with drugs such as oral bisphosphonates. One study focused on the clinical utility of modern spectrum of bone turnover markers for monitoring oral bisphosphonate therapy (alendronate, ibandronate, risedronate) in women with postmenopausal osteoporosis. The study concluded that two approaches could be used to identify response, namely a change beyond the least significant change or a change to below the mean value of bone turnover in healthy young women (1). This approach identified about 90% of women from the study as responding by 12 weeks on treatment. The International Osteoporosis Foundation and European Calcified Tissue Society proposed that a bone marker measurement made after 12 weeks was a good way to identify patients who are not adhering to therapy, as non-adherence is the commonest reason for non-response (2). The meet-the-expert session will examine the evidence for the use of bone turnover markers in treatment monitoring and give case examples of this approach in practice.

References

1. Naylor KE, Jacques RM, Paggiosi M, Gossiel F, Peel NF, McCloskey EV, Walsh JS, & Eastell R. Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study. Osteoporosis International 2016 27 21–31.

2. Diez-Perez A, Naylor KE, Abrahamsen B, Agnusdei D, Brandi ML, Cooper C, Dennison E, Eriksen EF, Gold DT, Guañabens N, et al. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporosis International 2017 28 767–774.