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Review
. 2025 Aug;89(2):356-364.
doi: 10.1007/s12020-025-04275-y. Epub 2025 May 29.

A practical use of bone turnover markers in management of patients with skeletal fragility

Alessandro Brunetti  1 , Miriam Cellini  1 , Valentina Vitale  2   3 , Lucrezia Maria Silvana Gentile  2   3 , Maria Francesca Birtolo  2   3 , Fabio Vescini  1 , Andrea Gerardo Lania  4   5 , Gherardo Mazziotti  2   3
Affiliations
Review

A practical use of bone turnover markers in management of patients with skeletal fragility

Alessandro Brunetti et al. Endocrine. 2025 Aug.

Abstract

Purpose: Bone turnover markers (BTMs) are metabolites produced during the bone remodeling cycle. BTMs can be distinguished in bone formation (procollagen type I N-terminal propeptide, bone-specific alkaline phosphatase and osteocalcin) and bone resorption markers (C-terminal telopeptide of type 1 collagen, N-terminal telopeptide of type 1 collagen and the tartrate-resistant isoform 5b of acid phosphatase). The evaluation of BTMs can offer dynamic information on bone turnover, making it a valuable tool for the management of patients with bone metabolic diseases.

Results: In the context of osteoporosis, BTMs have demonstrated utility in the monitoring of adherence and response to bone-active treatment, as well as in the management of treatment withdrawal. Additionally, they can be helpful in the evaluation of secondary osteoporosis, mainly when bone turnover is low. However, BTM assessment could be influenced by considerable biological and analytical variability, which must be addressed to ensure a correct clinical interpretation of the values. An accurate patient evaluation is therefore essential for selecting the most reliable biomarker to adopt in clinical practice and appropriate sample handling is critical for minimizing analytical variability.

Conclusions: In recent decades, the applications of BTMs in metabolic bone diseases have expanded significantly and future research will further highlight the role of these markers in the clinical management of osteoporosis.

Keywords: Anabolic drugs; Bisphosphonates; Bone turnover markers; Denosumab; Fractures; Osteoporosis.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: G.M. received fees for educational purposes from Amgen/UCB and Sanofi and lecture fees from Theramex and UCB, outside the submitted work. A.G.L. received grants from Pfizer and lecture fees from Recordati, outside the submitted work. F.V. received fees for educational purposes from IBSA and lecture fees from Theramex, Amgen, Bruno farmaceutici, IBSA, UCB, outside the submitted work. The other authors have nothing to declare. Ethics approval: Ethics approval is not required for this review article.

References

    1. J.A. Kanis et al., European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos. Int. 30(1), 3–44 (2019). - PubMed
    1. L. Cianferotti et al., Bone quality in endocrine diseases: determinants and clinical relevance. J. Endocrinol. Invest. 46(7), 1283–1304 (2023). - PubMed
    1. N.A. Sims, T.J. Martin, Coupling the activities of bone formation and resorption: a multitude of signals within the basic multicellular unit. Bonekey Rep. 3, 481 (2014). - PubMed - PMC
    1. S. Vasikaran et al., International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin. Chem. Lab. Med. 49(8), 1271–1274 (2011). - PubMed
    1. M. Schini et al., Bone turnover markers: basic biology to clinical applications. Endocr. Rev. 44(3), 417–473 (2023). - PubMed

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