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Cleveland Clinic Journal of Medicine

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Review

Bone turnover markers to monitor oral bisphosphonate therapy

Nikita Ashcherkin, MD, Archna A. Patel, MD, MPH, Alicia Algeciras-Schimnich, PhD and Krupa B. Doshi, MD, FACE
Cleveland Clinic Journal of Medicine January 2023, 90 (1) 26-31; DOI: https://doi.org/10.3949/ccjm.90a.22002
Nikita Ashcherkin
Department of Medicine, Mayo Clinic, Scottsdale, AZ
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Archna A. Patel
Department of Medicine, Mayo Clinic, Scottsdale, AZ
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Alicia Algeciras-Schimnich
Professor of Laboratory Medicine and Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Krupa B. Doshi
Assistant Professor of Medicine, Division of Endocrinology, Department of Medicine, Mayo Clinic, Scottsdale, AZ
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ABSTRACT

Bisphosphonates are widely used as first-line therapy to slow bone loss and decrease fracture risk in postmenopausal women with osteoporosis. Nonadherence to oral bisphosphonates diminishes the benefit of reduced bone loss and fracture risk of these medications. Strategies to enhance osteoporosis monitoring and adherence to therapy are crucial to improve outcomes. Dual-energy x-ray absorptiometry (DXA) is the gold standard for monitoring bone mineral density but is slow to detect change after initiation of oral bisphosphonate therapy. Bone turnover markers (BTMs) are by-products released during bone remodeling and are measurable in blood and urine. We review how the rapid change in BTMs can be a useful short-term tool to monitor the effectiveness of oral bisphosphonate therapy, which may ultimately improve adherence to therapy and outcomes.

  • Copyright © 2023 The Cleveland Clinic Foundation. All Rights Reserved.
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  1. Nikita Ashcherkin, MD
  1. Department of Medicine, Mayo Clinic, Scottsdale, AZ
  1. Archna A. Patel, MD, MPH
  1. Department of Medicine, Mayo Clinic, Scottsdale, AZ
  1. Alicia Algeciras-Schimnich, PhD
  1. Professor of Laboratory Medicine and Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
  1. Krupa B. Doshi, MD, FACE⇑
  1. Assistant Professor of Medicine, Division of Endocrinology, Department of Medicine, Mayo Clinic, Scottsdale, AZ
  1. Address:
    Krupa B. Doshi, MD, FACE, Division of Endocrinology, Department of Medicine, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ 85259; Doshi.Krupa{at}mayo.edu

ABSTRACT

Bisphosphonates are widely used as first-line therapy to slow bone loss and decrease fracture risk in postmenopausal women with osteoporosis. Nonadherence to oral bisphosphonates diminishes the benefit of reduced bone loss and fracture risk of these medications. Strategies to enhance osteoporosis monitoring and adherence to therapy are crucial to improve outcomes. Dual-energy x-ray absorptiometry (DXA) is the gold standard for monitoring bone mineral density but is slow to detect change after initiation of oral bisphosphonate therapy. Bone turnover markers (BTMs) are by-products released during bone remodeling and are measurable in blood and urine. We review how the rapid change in BTMs can be a useful short-term tool to monitor the effectiveness of oral bisphosphonate therapy, which may ultimately improve adherence to therapy and outcomes.

  • Copyright © 2023 The Cleveland Clinic Foundation. All Rights Reserved.
View Full Text
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Cleveland Clinic Journal of Medicine: 90 (1)
Cleveland Clinic Journal of Medicine
Vol. 90, Issue 1
1 Jan 2023
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Bone turnover markers to monitor oral bisphosphonate therapy
Nikita Ashcherkin, Archna A. Patel, Alicia Algeciras-Schimnich, Krupa B. Doshi
Cleveland Clinic Journal of Medicine Jan 2023, 90 (1) 26-31; DOI: 10.3949/ccjm.90a.22002

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Bone turnover markers to monitor oral bisphosphonate therapy
Nikita Ashcherkin, Archna A. Patel, Alicia Algeciras-Schimnich, Krupa B. Doshi
Cleveland Clinic Journal of Medicine Jan 2023, 90 (1) 26-31; DOI: 10.3949/ccjm.90a.22002
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  • Article
    • ABSTRACT
    • BONE TURNOVER MARKERS: CLINICAL OVERVIEW
    • SPECIMEN REQUIREMENTS FOR MONITORING
    • BONE TURNOVER MARKERS AND ORAL BISPHOSPHONATE THERAPY
    • BONE TURNOVER MARKERS AND BISPHOSPHONATE ‘DRUG HOLIDAY’
    • BONE TURNOVER MARKERS TO MONITOR PATIENT ADHERENCE
    • LIMITATIONS OF BONE TURNOVER MARKERS
    • DISCLOSURES
    • REFERENCES
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