Biochemical Markers of Osteoporosis

Determination of the rate of bone remodeling is an important aspect in osteoporosis, especially to find out the response to the treatment of osteoporosis with medications approved for treatment of osteoporosis. An index of the overall rate of bone remodeling can be determined with the help of several biochemical tests (by detecting biochemical markers) that are available. Biochemical markers are related to bone formation or bone resorption. The biochemical tests can measure the overall state of bone remodeling at a single point in time by detecting biochemical markers. But the major drawbacks such as analytical variability (this is improving) and biologic variability (due to circadian rhythm) are limiting clinical use of biochemical tests/biochemical markers.

The primary use of biochemical markers is to monitor the response to treatment. The bone remodeling markers in most cases can not  predict rates of bone loss accurately, that it can be used in clinical practice, but the bone resorption markers can help in the prediction of fracture risk (independent of bone density), especially in older people. In women of 65 years or higher age a high level of bone resorption can be used for consideration of treatment, if the bone density results are greater than the usual treatment threshold.

The use of antiresorptive therapeutic agents (such as bisphosphonates), bone remodeling can be brought down rapidly and fall in resorption occurs earlier than the fall in formation. The inhibition of bone resorption maximum in first 3-6 months of initiation of therapy and measurement of bone resorption by biochemical markers before and at 4-6 moths after initiation of therapy can estimate of patient response to therapy.

Biochemical markers of bone metabolism in clinical use:

For measuring bone formation: Serum bone-specific alkaline phosphatase, serum osteocalcin, serum propeptide of type I procollagen etc.

For measuring bone resorption: Urine and serum cross-linked N-telopeptide, urine total free deoxypyridinoline, urine and serum cross-linked C-telopeptide etc.

Bone biopsy in osteoporosis:

At present bone biopsy is not used in osteoporosis due to current use of BMD (bone mineral density) tests, along with hormonal evaluation and biochemical markers of bone remodeling, which are commonly used. But bone biopsy still has use in research.

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