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Algorithm for the use of biochemical markers of bone turnover on the diagnosis, assessment and follow-up of treatment for osteoporosis

Algorithm for the use of biochemical markers of bone turnover on the diagnosis, assessment and follow-up of treatment for osteoporosis
Algorithm for the use of biochemical markers of bone turnover on the diagnosis, assessment and follow-up of treatment for osteoporosis
Introduction: increased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication.

Methods: a working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Results: serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence.

Conclusion: in conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy.
0741-238X
Lorentzen, Mattias
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Branco, Jaime
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Brandi, Maria Luisa
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Bruyère, Olivier
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Chapurlat, Roland
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Cooper, Cyrus
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Cortet, B.
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Diez-Perez, A.
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Ferrari, S.
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Gasparik, A.I.
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Herrmann, M.
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Rye Jørgensen, Niklas
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Kanis, John A.
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Kaufman, Jean-Marc
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Laslop, Andrea
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Locquet, Médéa
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Matijevic, Radmila
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McCloskey, Eugene
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Minisola, Salvatore
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Pickner, Richard
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Reginster, Jean-Yves
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Rizzoli, Rene
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Szulc, Pawel
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Vlaskovska, Mila
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Cavalier, Etienne
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Lorentzen, Mattias
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Branco, Jaime
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Brandi, Maria Luisa
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Bruyère, Olivier
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Chapurlat, Roland
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Cooper, Cyrus
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Cortet, B.
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Diez-Perez, A.
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Ferrari, S.
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Gasparik, A.I.
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Herrmann, M.
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Rye Jørgensen, Niklas
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Kanis, John A.
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Kaufman, Jean-Marc
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Laslop, Andrea
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Locquet, Médéa
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Matijevic, Radmila
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McCloskey, Eugene
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Minisola, Salvatore
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Pickner, Richard
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Reginster, Jean-Yves
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Rizzoli, Rene
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Szulc, Pawel
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Vlaskovska, Mila
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Cavalier, Etienne
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Lorentzen, Mattias, Branco, Jaime, Brandi, Maria Luisa, Bruyère, Olivier, Chapurlat, Roland, Cooper, Cyrus, Cortet, B., Diez-Perez, A., Ferrari, S., Gasparik, A.I., Herrmann, M., Rye Jørgensen, Niklas, Kanis, John A., Kaufman, Jean-Marc, Laslop, Andrea, Locquet, Médéa, Matijevic, Radmila, McCloskey, Eugene, Minisola, Salvatore, Pickner, Richard, Reginster, Jean-Yves, Rizzoli, Rene, Szulc, Pawel, Vlaskovska, Mila and Cavalier, Etienne (2019) Algorithm for the use of biochemical markers of bone turnover on the diagnosis, assessment and follow-up of treatment for osteoporosis. Advances in Therapy. (doi:10.1007/s12325-019-01063-9).

Record type: Article

Abstract

Introduction: increased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication.

Methods: a working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Results: serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence.

Conclusion: in conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy.

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ESCEO Markers Advances in therapy V4 - Accepted Manuscript
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More information

Accepted/In Press date: 1 August 2019
e-pub ahead of print date: 22 August 2019

Identifiers

Local EPrints ID: 434092
URI: http://eprints.soton.ac.uk/id/eprint/434092
ISSN: 0741-238X
PURE UUID: 4bec6c2f-31f8-4212-8d33-8fde15d4ab4a
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 12 Sep 2019 16:30
Last modified: 26 Nov 2021 02:40

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Contributors

Author: Mattias Lorentzen
Author: Jaime Branco
Author: Maria Luisa Brandi
Author: Olivier Bruyère
Author: Roland Chapurlat
Author: Cyrus Cooper ORCID iD
Author: B. Cortet
Author: A. Diez-Perez
Author: S. Ferrari
Author: A.I. Gasparik
Author: M. Herrmann
Author: Niklas Rye Jørgensen
Author: John A. Kanis
Author: Jean-Marc Kaufman
Author: Andrea Laslop
Author: Médéa Locquet
Author: Radmila Matijevic
Author: Eugene McCloskey
Author: Salvatore Minisola
Author: Richard Pickner
Author: Jean-Yves Reginster
Author: Rene Rizzoli
Author: Pawel Szulc
Author: Mila Vlaskovska
Author: Etienne Cavalier

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