Bone Biomarkers: Clinical Application

Osteoporosis and fragility fractures are associated with low bone strength. Bone strength is dependent on both bone density and bone quality, which are affected by bone remodeling and turnover. As a marker of bone remodeling, bone turnover biomarkers give important information about the physiological state of bone. Bone biomarkers include bone resorption markers and bone formation markers and can be measured in the serum and urine. There are multiple sources of controllable and uncontrollable variability in bone biomarkers, which must be taken into consideration during their clinical use and interpretation. Studies have shown that bone biomarkers can add to clinical assessment of fracture risk, especially imminent fracture risk, and can aid in the monitoring of therapy. Changes in bone biomarkers happen faster than changes in bone mineral density (BMD) with antiresorptive and anabolic therapy. While there is potential for the use of bone biomarkers beyond fracture risk assessment and monitoring therapy, current guidelines do not include strong recommendations for routine clinical use until further studies and evidence are available. Further studies looking at potential future clinical applications, including aiding in the choice of therapy, and frequency and duration of therapy, are warranted.