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Osteoporosis is a major health problem worldwide and is projected to increase exponentially due to the aging of the population. Fractures, the most dreaded complication of bone disease are associated with high co-morbidity and mortality. The consequent public health and socioeconomic burden thus warrant timely diagnosis, treatment and follow-up of these disorders. Biochemical markers of bone turnover are convenient as the changes in their levels readily reflect bone physiology. Currently literature data advocate bone biomarkers as best used in monitoring anti-osteoporosis therapy efficacy and compliance, however there is abundant data supporting their role in predicting bone loss and fracture risk. Although dual energy x-ray absorptiometry (DEXA) is the gold standard to assess bone mass it does not account for fracture risk. Bone mineral density (BMD) measurement by DEXA has its own limitations being invasive, expensive and un- availability of machines at the primary level. Moreover changes in BMD measurements are static, reflecting at a particular site and observed after a year unlike changes in the bone turnover makers (BTMs) which occur within months of therapy. Due to these limitations, measurement of biomarkers from blood samples is an attractive alternative to evaluate bone turnover. The pre and post-analytic implications of bone turnover markers is mandatory in correct interpretation of test results. This mini review summarizes the most widely used BTMs, a look at more novel markers and discusses their strengths, weaknesses, feasibility of development of immunoassays, pre analytical issues and their clinical utility in the management of osteoporosis.
Keywords: Bone turnover markers, Hormones, Cytokines, Osteoporosis
Abbreviations: BMD: Bone Mineral Density; BSAP: Bone-Specific Alkaline Phosphatase; BTM: Bone Turnover Maker; Cr: Creatinine; CTX: C-Terminal Telopeptide of Type I Collagen; NTX: N-Terminal Telopeptide of Type I Collagen; DEXA: Dual Energy X-Ray Absorptiometry; DPD: Deoxypyridinoline; E1G: Estrone Glucuronide; ELISA: Enzyme Linked Immunosorbent Assay; FSH: Follicle Stimulating Hormone; HRT: Hormone Replacement Therapy; IL: Interleukin; OB: Osteoblast; OC: Osteoclast; OPG: Osteoprotegerin; OSC: Osteocalcin; PICP: C-Terminal Propeptide of Type I Collagen; PINP: N-terminal Propeptide of Type I Collagen; POF: Premature Ovarian Failure; PTH: Parathyroid Hormone; PyD: Pyridinoline; RANK: Receptor Activator of Nuclear Factor-Kappa B; RANKL: Receptor Activator of Nuclear Factor-Kappa B Ligand; TRAP: Tartrate-Resistant Acid Phosphatase
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