Clinical utility of bone markers in various diseases

• Published in: Bone (New York, N.Y.) Vol. 114; pp. 215 - 225
• Main Authors: Vlot, M.C., den Heijer, M., de Jongh, R.T., Vervloet, M.G., Lems, W.F., de Jonge, R., Obermayer-Pietsch, B., Heijboer, A.C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2018
• Subjects: BALP; Biomarkers - blood; Biomarkers - urine; Bone derived hormones; Bone Diseases - blood; Bone Diseases - diagnosis; Bone Diseases - urine; Bone markers; Bone Remodeling - physiology; Bone turnover; Clinical utility; CTX-I; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - urine; FGF23; Humans; Hypophosphatemic disease; Metabolic bone disease; Osteitis Deformans - blood; Osteitis Deformans - diagnosis; Osteoblast; Osteocalcin; Osteoclast; Osteocyte; Osteoporosis; Osteoporosis - blood; Osteoporosis - diagnosis; Osteoporosis - urine; Paget; PINP; Review; Sclerostin; Tumor induced osteomalacia; van Buchem disease; Osteocalcin; Bone derived hormones; Osteoclast; Bone turnover; Review; Hypophosphatemic disease; Bone markers; Metabolic bone disease; Clinical utility; Paget; Osteoporosis; CTX-I; Tumor induced osteomalacia; Osteoblast; Sclerostin; van Buchem disease; Osteocyte; FGF23; BALP; PINP
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2018.06.011

Measurements of bone markers (BMs) in peripheral blood or urine are a pivotal part of bone research within modern clinical medicine. In recent years the use of BMs increased substantially as they can be useful either to diagnose bone (related) disease and to follow its natural history, but also to monitor the effects of interventions. However, the use of BMs is still complicated mainly due to (pre)analytical variability of these substances, limited accessibility of assays, variable cut-off values in different countries and laboratories and heterogeneous results with regard to clinical implications of measuring BMs in several studies. This review will provide the clinician with a practical guide, based on current evidence, in which circumstances to test which bone markers for optimal diagnostic purposes, in order to improve patient care in different areas of bone diseases including Paget's disease, primary osteoporosis, tumor induced osteomalacia, hypophosphatemic rickets, van Buchem disease, chronic kidney disease, rheumatoid arthritis, neoplasma/multiple myeloma, type 2 diabetes mellitus and primary hyperparathyroidism. The clinician should consider fasting state, recent fractures, aging, menopausal status, concomitant liver and kidney disease when ordering and interpreting BM measurements as these factors might result in misleading BM concentrations. We found that BMs are clearly useful in the current diagnosis of tumor induced osteomalacia, van Buchem disease, Paget's disease and hypophosphatemic rickets. In addition, BMs are useful to monitor disease activity in chronic kidney disease, Paget's disease and are useful to monitor treatment adherence in osteoporosis. •MMeasurements of bone markers (BMs) in blood or urine are a pivotal part of bone research within modern clinical medicine•Clinical use of BMs is complicated due to (pre)analytical variability, limited access to assays and variable cut-off values•Measuring BMs can help diagnose tumor induced osteomalacia, van Buchem disease, Paget’s disease and hypophosphatemic rickets•BMs are useful to monitor disease activity in chronic kidney disease and Paget’s disease and treatment effect in osteoporosis