Algorithm for the Use of Biochemical Markers of Bone Turnover in the Diagnosis, Assessment and Follow-Up of Treatment for Osteoporosis

Mattias Lorentzon, Jaime Branco, Maria Luisa Brandi, Olivier Bruyère, Roland Chapurlat, Cyrus Cooper, Bernard Cortet, Adolfo Diez-Perez, Serge Ferrari, Andrea Gasparik, Markus Herrmann, Niklas Rye Jorgensen, John Kanis, Jean Marc Kaufman, Andrea Laslop, Médéa Locquet, Radmila Matijevic, Eugene McCloskey, Salvatore Minisola, Richard Pikner & 5 others Jean Yves Reginster, René Rizzoli, Pawel Szulc, Mila Vlaskovska, Etienne Cavalier

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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.

Original languageEnglish
JournalAdvances In Therapy
Volume36
Issue number10
DOIs
Publication statusPublished - Oct 2019

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Bone Remodeling
Osteoporosis
Biomarkers
Bone and Bones
Diphosphonates
Serum
Therapeutics
Musculoskeletal Diseases
Postmenopausal Osteoporosis
Osteogenesis
Osteoarthritis
Bone Density
Economics
Sensitivity and Specificity

Keywords

  • Algorithm
  • Bone
  • Bone biomarker
  • CTX
  • Osteoporosis
  • P1NP
  • Rheumatology

Cite this

Lorentzon, Mattias ; Branco, Jaime ; Brandi, Maria Luisa ; Bruyère, Olivier ; Chapurlat, Roland ; Cooper, Cyrus ; Cortet, Bernard ; Diez-Perez, Adolfo ; Ferrari, Serge ; Gasparik, Andrea ; Herrmann, Markus ; Jorgensen, Niklas Rye ; Kanis, John ; Kaufman, Jean Marc ; Laslop, Andrea ; Locquet, Médéa ; Matijevic, Radmila ; McCloskey, Eugene ; Minisola, Salvatore ; Pikner, Richard ; Reginster, Jean Yves ; Rizzoli, René ; Szulc, Pawel ; Vlaskovska, Mila ; Cavalier, Etienne. / Algorithm for the Use of Biochemical Markers of Bone Turnover in the Diagnosis, Assessment and Follow-Up of Treatment for Osteoporosis. In: Advances In Therapy. 2019 ; Vol. 36, No. 10.
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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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author = "Mattias Lorentzon and Jaime Branco and Brandi, {Maria Luisa} and Olivier Bruy{\`e}re and Roland Chapurlat and Cyrus Cooper and Bernard Cortet and Adolfo Diez-Perez and Serge Ferrari and Andrea Gasparik and Markus Herrmann and Jorgensen, {Niklas Rye} and John Kanis and Kaufman, {Jean Marc} and Andrea Laslop and M{\'e}d{\'e}a Locquet and Radmila Matijevic and Eugene McCloskey and Salvatore Minisola and Richard Pikner and Reginster, {Jean Yves} and Ren{\'e} Rizzoli and Pawel Szulc and Mila Vlaskovska and Etienne Cavalier",
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Lorentzon, M, Branco, J, Brandi, ML, Bruyère, O, Chapurlat, R, Cooper, C, Cortet, B, Diez-Perez, A, Ferrari, S, Gasparik, A, Herrmann, M, Jorgensen, NR, Kanis, J, Kaufman, JM, Laslop, A, Locquet, M, Matijevic, R, McCloskey, E, Minisola, S, Pikner, R, Reginster, JY, Rizzoli, R, Szulc, P, Vlaskovska, M & Cavalier, E 2019, 'Algorithm for the Use of Biochemical Markers of Bone Turnover in the Diagnosis, Assessment and Follow-Up of Treatment for Osteoporosis', Advances In Therapy, vol. 36, no. 10. https://doi.org/10.1007/s12325-019-01063-9

Algorithm for the Use of Biochemical Markers of Bone Turnover in the Diagnosis, Assessment and Follow-Up of Treatment for Osteoporosis. / Lorentzon, Mattias; Branco, Jaime; Brandi, Maria Luisa; Bruyère, Olivier; Chapurlat, Roland; Cooper, Cyrus; Cortet, Bernard; Diez-Perez, Adolfo; Ferrari, Serge; Gasparik, Andrea; Herrmann, Markus; Jorgensen, Niklas Rye; Kanis, John; Kaufman, Jean Marc; Laslop, Andrea; Locquet, Médéa; Matijevic, Radmila; McCloskey, Eugene; Minisola, Salvatore; Pikner, Richard; Reginster, Jean Yves; Rizzoli, René; Szulc, Pawel; Vlaskovska, Mila; Cavalier, Etienne.

In: Advances In Therapy, Vol. 36, No. 10, 10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Algorithm for the Use of Biochemical Markers of Bone Turnover in the Diagnosis, Assessment and Follow-Up of Treatment for Osteoporosis

AU - Lorentzon, Mattias

AU - Branco, Jaime

AU - Brandi, Maria Luisa

AU - Bruyère, Olivier

AU - Chapurlat, Roland

AU - Cooper, Cyrus

AU - Cortet, Bernard

AU - Diez-Perez, Adolfo

AU - Ferrari, Serge

AU - Gasparik, Andrea

AU - Herrmann, Markus

AU - Jorgensen, Niklas Rye

AU - Kanis, John

AU - Kaufman, Jean Marc

AU - Laslop, Andrea

AU - Locquet, Médéa

AU - Matijevic, Radmila

AU - McCloskey, Eugene

AU - Minisola, Salvatore

AU - Pikner, Richard

AU - Reginster, Jean Yves

AU - Rizzoli, René

AU - Szulc, Pawel

AU - Vlaskovska, Mila

AU - Cavalier, Etienne

PY - 2019/10

Y1 - 2019/10

N2 - 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.

AB - 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.

KW - Algorithm

KW - Bone

KW - Bone biomarker

KW - CTX

KW - Osteoporosis

KW - P1NP

KW - Rheumatology

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U2 - 10.1007/s12325-019-01063-9

DO - 10.1007/s12325-019-01063-9

M3 - Article

VL - 36

JO - Advances In Therapy

JF - Advances In Therapy

SN - 0741-238X

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