CLINICAL VALUE OF THE BIOCHEMICAL MARKERS OF BONE REMODELING IN THE ASSESSMENT OF BONE METABOLIC DISEASES

Summary: Bone markers have been useful research tools, with their clinical utility limited by their specific technical and analytical aspects and pre-analytical variability. Bone markers reflect different aspects of the quality of bone than BMD and, therefore, may add an independent, predictive value to the assessment of changes in bone mineral density and reductions in the risk of fracture. The decrease in bone marker levels is strongly related to the reduction in vertebral fracture risk through raloxifene, risedronate and alendronate. After anabolic therapy with teriparatide, early increases in bone formation markers are strong predictors of BMD responses. There are potential advantages of using markers for monitoring anti-osteoporosis treatment in the short term, in addition to the bone mineral measurements, to identify non-responders or non-compliance. The transition of biochemical bone markers into everyday clinical practice requires standardization of assays and quality control programs to reduce large inter-laboratory variations of data, defining criteria of a high bone turnover in terms of reference values, either young adult or age-matched, and better characterization of the markers across geographic areas and races and under various clinical conditions.