The Utility of Biomarkers in Osteoporosis Management

Mol Diagn Ther. 2017 Aug;21(4):401-418. doi: 10.1007/s40291-017-0272-1.


The measurement of bone turnover markers is useful for the clinical investigation of patients with osteoporosis. Among the available biochemical markers, the measurements of serum procollagen type I N-terminal propeptide (PINP) and the crosslinked C-terminal telopeptide (serum CTX) have been recommended as reference markers of bone formation and bone resorption, respectively. The important sources of preanalytical and analytical variability have been identified for both markers, and precise measurement can now be obtained. Reference interval data for PINP and CTX have been generated across different geographical locations, which allows optimum clinical interpretation. However, conventional protein-based markers have some limitations, including a lack of specificity for bone tissue, and their inability to reflect osteocyte activity or periosteal metabolism. Thus, novel markers such as periostin, sclerostin and, sphingosine 1-phosphate have been developed to address some of these shortcomings. Recent studies suggest that the measurements of circulating microRNAs, a new class of marker, may represent early biological markers in osteoporosis. Bone markers have been shown to be a useful adjunct to bone mineral density for identifying postmenopausal women at high risk for fracture. Because levels of bone markers respond rapidly to both anabolic and anticatabolic drugs, they are very useful for investigating the mechanism of action of new therapies and, potentially, for predicting their efficacy to reduce fracture risk.

Publication types

  • Review

MeSH terms

  • Adaptor Proteins, Signal Transducing
  • Biomarkers / blood
  • Bone Density / drug effects
  • Bone Density Conservation Agents / therapeutic use
  • Bone Morphogenetic Proteins / blood
  • Bone Resorption / blood
  • Bone Resorption / diagnosis*
  • Bone Resorption / drug therapy
  • Bone Resorption / pathology
  • Cell Adhesion Molecules / blood
  • Collagen Type I / blood*
  • Disease Management
  • Female
  • Genetic Markers
  • Humans
  • Lysophospholipids / blood
  • MicroRNAs / blood*
  • Osteoporosis / blood
  • Osteoporosis / diagnosis*
  • Osteoporosis / drug therapy
  • Osteoporosis / pathology
  • Peptide Fragments / blood*
  • Peptides / blood*
  • Postmenopause / blood
  • Procollagen / blood*
  • Prognosis
  • Sphingosine / analogs & derivatives
  • Sphingosine / blood


  • Adaptor Proteins, Signal Transducing
  • Biomarkers
  • Bone Density Conservation Agents
  • Bone Morphogenetic Proteins
  • Cell Adhesion Molecules
  • Collagen Type I
  • Genetic Markers
  • Lysophospholipids
  • MicroRNAs
  • POSTN protein, human
  • Peptide Fragments
  • Peptides
  • Procollagen
  • SOST protein, human
  • collagen type I trimeric cross-linked peptide
  • procollagen Type I N-terminal peptide
  • sphingosine 1-phosphate
  • Sphingosine