Prognostic interest of bone turnover markers in the management of postmenopausal osteoporosis

ObjectiveThe aim was to review the literature dealing with the use of biochemical bone turnover markers (BTM) as predictors of bone loss and individual risk of fracture in postmenopausal osteoporosis.MethodsWe performed a generalized search in MEDLINE using Mesh Database from 1995 through 2009 with the following terms “biological markers” with “osteoporosis” or “bone resorption”, or “bone fracture”, “fracture risk”. From this research, 197 abstracts were read, 91 articles were screened then 43 original articles were selected.ResultsIn most of the selected articles, the upper limit of the premenopausal range was used as a cut-off definition for increased bone resorption. Based on this review, we found a moderate and positive relationship between baseline level of BTM and rate of bone loss, more particularly for high level of BTM over 2 SD, especially when high turnover is constant in repeated sampling. In addition, an increase in BTM levels is associated with an increase in the risk of hip and non-vertebral fractures in elderly women over 75 years old. This is especially demonstrated with bone resorption markers (e.g. uCTX) in the highest quartile with an 1.7 to 2.2 fold increase. The combination of data from bone mineral density (BMD) and bone resorption markers may improve fracture prediction.ConclusionThe measurement of BTM, together with the assessment of other risk factors including low BMD, will improve the prediction of risk facture, but there is a lack of practical guidelines.