Endocrine Abstracts

In common with other chronic conditions, persistence with treatment for osteoporosis is poor, with fewer than 50% of patients continuing treatment by 12 months. Reasons for this are multifactorial; treatment does not lead to symptomatic benefit, may be difficult to take and can cause adverse effects. Furthermore, poor compliance may not be overt and may be unintentional. Monitoring an individual’s response to treatment can identify those with suboptimal response. Potential tools to monitor osteoporosis treatment include serial measurement of bone mineral density (BMD) and the use of bone turnover markers (BTM). BTM reflect the processes of bone resorption and formation. They have been shown to be determinants of fracture risk and predictors of accelerated bone loss in cohort studies. However, in the management of the individual patient with osteoporosis the main role for BTM is as a tool to monitor treatment response. BTM can be used to evaluate response to both anti-resorptive and anabolic therapies and have the advantage over serial measurements of BMD of showing large, early changes, enabling identification of treatment response within just weeks of initiating therapy. Care is required in sample collection, analysis and interpretation to optimise clinical utility. An attenuated or absent response to treatment may indicate poor compliance or the presence of an untreated underlying cause of osteoporosis. Poor compliance is the most common reason for poor treatment response and monitoring may be effective in enhancing compliance and clinical efficacy. However, it remains to be established whether this approach is cost-effective.

References: Eastell R, Pigott T, Gossiel F, Naylor KE, Walsh JS, Peel NFA. Diagnosis of endocrine disease: Bone turnover markers: are they clinically useful? Eur J Endocrinol. 2018 Jan;178(1):R19–R31. doi: 10.1530/EJE-17-0585. Epub 2017 Oct 18. PMID: 29046326.