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Bone turnover markers

Bone turnover markers
Formation Assay Circadian rhythm LSC Comments
OC S* Y 21% Lack of standardization, rapidly degraded in serum, requires collection on ice
BSAP S* N 28% Cross-reactivity with liver isoform (15 to 20%)
PINP/PICP S* Y 21%/24%  
Resorption
NTX U*,S Y 35% (S), 70% (U)  
CTX U,S* Y 30% (S), 80% (U)  
D-PYR U Y 26%  
PYD U* Y 36%  
HYP U     Reflects bone resorption and dietary intake
TRACP5b S Y 17%  
LSC: least significant change; OC: osteocalcin; S: serum, collection of serum should be performed in the morning after an overnight fast; BSAP: bone-specific alkaline phosphatase; PINP: N-terminal propeptide of type I procollagen; PICP: C-terminal propeptide of type I procollagen; NTX: N-telopeptide of type I collagen; U: urinary excretion, collection of urine should be performed in the morning (usually second AM void, fasting); CTX: C-telopeptide of type I collagen; D-PYR: free deoxypyridinoline; PYD: free pyridinoline; HYP: hydroxyproline; TRACP5b: isoform 5b of tartrate resistant acid phosphatase; circadian rhythm: higher in the early morning.
* Automated technology for measurement is available.
Data from:
  1. Bergmann P, Body JJ, Boonen S, et al. Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: A consensus document of the Belgian Bone Club. Int J Clin Pract 2009; 63:19.
  2. Scariano JK, Garry PJ, Montoya GD, et al. Critical differences in the serial measurement of three biochemical markers of bone turnover in the sera of pre-and postmenopausal women. Clin Biochem 2001; 34:639.
  3. Baim S, Miller PD. Assessing the clinical utility of serum CTX in postmenopausal osteoporosis and its use in predicting risk of osteonecrosis of the jaw. J Bone Miner Res 2009; 24:561.
  4. Hannon R, Blumsohn A, Naylor K, Eastell R. Response of biochemical markers of bone turnover to hormone replacement therapy: Impact of biological variability. J Bone Miner Res 1998; 13:1124.
  5. Rosen HN, Parker RA, Greenspan SL, et al. Evaluation of ability of biochemical markers of bone turnover to predict a response to increased doses of HRT. Calcif Tissue Int 2004; 74:415.
  6. Miller PD, Baran DT, Bilezikian JP, et al. Practical clinical application of biochemical markers of bone turnover: Consensus of an expert panel. J Clin Denistom 1999; 2:323.
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