Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
Adv Ther. 2019 Oct;36(10):2811-2824. doi: 10.1007/s12325-019-01063-9. Epub 2019 Aug 22.
Increased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication.
A working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).
Serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence.
In conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy.
血清中骨转换生化标志物（BTMs）的升高与骨丢失、骨折风险增加和治疗依从性差有关，但目前其在临床实践中的作用尚不清楚。本共识小组报告的目的是为临床医生提供指导，说明如何在绝经后骨质疏松症患者评估、骨折风险预测以及骨质疏松症药物治疗效果和依从性监测中使用 BTMs。
临床科学家和骨质疏松专家工作组应欧洲临床和经济骨质疏松、骨关节炎和肌肉骨骼疾病学会（ESCEO）科学顾问委员会的邀请，参与了这项研究。
血清骨形成标志物 PINP 和骨吸收标志物 βCTX-I 是评估临床环境中骨转换的首选标志物，因为它们具有骨特异性、在临床研究中的表现、广泛应用和相对较低的分析变异性。由于灵敏度和特异性低，BTMs 不能用于诊断骨质疏松症，但在评估患者时可能有价值，如果值较高，可能需要调查一些继发性骨质疏松症的原因。评估血清 βCTX-I 和 PINP 水平可以略微提高骨折预测的准确性，除了临床危险因素和骨密度外，骨标志物每增加一个标准差，风险增加约 1.2 倍。对于个体患者，BTMs 对预测骨丢失或治疗效果没有帮助，但建议使用血清 PINP 和 βCTX-I 来监测口服双膦酸盐治疗的依从性。BTMs 的抑制程度大于最小有意义变化或达到年轻健康绝经前女性参考区间的下半部分与治疗依从性密切相关。
综上所述，目前的证据表明，BTMs 的主要临床用途是监测口服双膦酸盐治疗。
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