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Monitoring pharmacological therapy for osteoporosis

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Abstract

Osteoporosis is a common disease characterized by low bone strength that increases the risk of fractures. The consequences of fractures include increases in morbidity, mortality, and healthcare costs. Randomized clinical trials have shown that pharmacological therapy can reduce the risk of fractures. In clinical practice, however, failure to achieve optimal therapeutic benefit is common for reasons that include taking medication incorrectly, stopping it prematurely, malabsorption, and the presence of unrecognized diseases or conditions with adverse skeletal effects. Monitoring for anti-fracture effectiveness in individual patients is limited by the absence of clinical tools to directly measure bone strength. It is therefore necessary to monitor therapy with biomarkers such as bone mineral density and bone turnover markers. This is a review of the utility of these tools in the care of individual patients.

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References

  1. Klibanski A, Adams-Campbell L, Bassford T, Blair SN, Boden SD, Dickersin K, et al. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785–95.

    Article  Google Scholar 

  2. WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: World Health Organization; 1994.

    Google Scholar 

  3. Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, et al. Official positions of the international society for clinical densitometry and executive summary of the 2007 ISCD position development conference. J Clin Densitom. 2008;11(1):75–91.

    Article  PubMed  Google Scholar 

  4. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington: National Osteoporosis Foundation; 2008.

    Google Scholar 

  5. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005;293(18):2257–64.

    Article  CAS  PubMed  Google Scholar 

  6. Dawson-Hughes B, Harris SS, Krall EA, Dallal G. Effects of calcium and vitamin D supplementation on bone density in men and women 65 years of age and older. N Engl J Med. 1997;337:670–6.

    Article  CAS  PubMed  Google Scholar 

  7. Liberman UA, Weiss SR, Broll J, Minne H, Quan H, Bell NH, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med. 1995;333:1437–43.

    Article  CAS  PubMed  Google Scholar 

  8. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996;348:1535–41.

    Article  CAS  PubMed  Google Scholar 

  9. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures—results from the fracture intervention trial. JAMA. 1998;280(24):2077–82.

    Article  CAS  PubMed  Google Scholar 

  10. Chesnut III CH, Silverman S, Andriano K, Genant H, Gimona A, Harris S, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med. 2000;109(4):267–76.

    Article  CAS  PubMed  Google Scholar 

  11. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene—results from a 3-year randomized clinical trial. JAMA. 1999;282(7):637–45.

    Article  CAS  PubMed  Google Scholar 

  12. McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, et al. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med. 2001;344:333–40.

    Article  CAS  PubMed  Google Scholar 

  13. Reginster J-Y, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int. 2000;11:83–91.

    Article  CAS  PubMed  Google Scholar 

  14. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) study group. JAMA. 1999;282(14):1344–52.

    Article  CAS  PubMed  Google Scholar 

  15. Chesnut III CH, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004;19(8):1241–9.

    Article  CAS  Google Scholar 

  16. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster J-Y, et al. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434–41.

    Article  CAS  PubMed  Google Scholar 

  17. Greenspan SL, Bone HG, Ettinger MP, Hanley DA, Lindsay R, Zanchetta JR, et al. Effect of recombinant human parathyroid hormone (1–84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med. 2007;146(5):326–39.

    PubMed  Google Scholar 

  18. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356(18):1809–22.

    Article  CAS  PubMed  Google Scholar 

  19. Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357(18):1799–809.

    Article  CAS  PubMed  Google Scholar 

  20. Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab. 2005;90(5):2816–22.

    Article  CAS  PubMed  Google Scholar 

  21. Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med. 2004;350(5):459–68.

    Article  CAS  PubMed  Google Scholar 

  22. Silverman SL, Christiansen C, Genant HK, Vukicevic S, Zanchetta JR, de Villiers TJ, et al. Efficacy of bazedoxifene in reducing new vertebral fracture risk in postmenopausal women with osteoporosis: results from a 3-year, randomized, placebo-, and active-controlled clinical trial. J Bone Miner Res. 2008;23(12):1923–34.

    Article  CAS  PubMed  Google Scholar 

  23. Cummings SR, Eastell R, Ensrud K, Reid DM, Vukicevic S, Lacroix A, et al. The effects of lasofoxifene on fractures and breast cancer: 3-year results from the PEARL trial. J Bone Miner Res. 2008;23 Suppl 1:S81.

    Google Scholar 

  24. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA. 2002;288:321–33.

    Article  Google Scholar 

  25. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA. 2004;291(14):1701–12.

    Article  CAS  PubMed  Google Scholar 

  26. Dowd R, Recker RR, Heaney RP. Study subjects and ordinary patients. Osteoporosis Int. 2000;11(6):533–6.

    Article  CAS  Google Scholar 

  27. Wilkes MM, Navickis RJ, Chan WW, Lewiecki EM. Bisphosphonates and osteoporotic fractures: a cross-design synthesis of results among compliant/persistent postmenopausal women in clinical practice versus randomized controlled trials. Osteoporos Int. 2009;Jul 2;Epub.

  28. Vestergaard P, Rejnmark L, Mosekilde L. Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int. 2005;16(2):134–41.

    Article  PubMed  Google Scholar 

  29. Gehlbach SH, Fournier M, Bigelow C. Recognition of osteoporosis by primary care physicians. Am J Public Health. 2002;92(2):271–3.

    Article  PubMed  Google Scholar 

  30. Solomon DH, Finkelstein JS, Katz JN, Mogun H, Avorn J. Underuse of osteoporosis medications in elderly patients with fractures. Am J Med. 2003;115(5):398–400.

    Article  PubMed  Google Scholar 

  31. Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002;162(19):2217–22.

    Article  PubMed  Google Scholar 

  32. Panneman MJ, Lips P, Sen SS, Herings RM. Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int. 2004;15(2):120–4.

    Article  PubMed  Google Scholar 

  33. Kamel HK, Hussain MS, Tariq S, Perry III HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med. 2000;109(4):326–8.

    Article  CAS  PubMed  Google Scholar 

  34. Geller JL, Hu B, Reed S, Mirocha J, Adams JS. Increase in bone mass after correction of vitamin D insufficiency in bisphosphonate-treated patients. Endocr Pract. 2008;14(3):293–7.

    PubMed  Google Scholar 

  35. Cramer JA, Gold DT, Silverman SL, Lewiecki EM. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int. 2007;18(8):1023–31.

    Article  CAS  PubMed  Google Scholar 

  36. Lewiecki EM. Nonresponders to osteoporosis therapy. J Clin Densitom. 2003;6(4):307–14.

    Article  PubMed  Google Scholar 

  37. Lewiecki EM, Watts NB. Assessing response to osteoporosis therapy. Osteoporos Int. 2008;19(10):1363–8.

    Article  CAS  PubMed  Google Scholar 

  38. Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A. Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos Int. 2008;19(10):1395–408.

    Article  CAS  PubMed  Google Scholar 

  39. Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2008;19(4):399–428.

    Article  CAS  PubMed  Google Scholar 

  40. Fujiwara S, Nakamura T, Orimo H, Hosoi T, Gorai I, Oden A, et al. Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX). Osteoporos Int. 2008;19(4):429–35.

    Article  CAS  PubMed  Google Scholar 

  41. Kurth AA, Pfeilschifter J. Diagnosis and treatment of postmenopausal osteoporosis and osteoporosis in men. German Guidelines Update 2006. Orthopade. 2007;36(7):683–90.

    Article  CAS  PubMed  Google Scholar 

  42. Siminoski K, Leslie WD, Frame H, Hodsman A, Josse RG, Khan A, et al. Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment. J Clin Densitom. 2007;10(2):120–3.

    Article  PubMed  Google Scholar 

  43. Biomarkers Definitions Working Group. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther. 2001;69(3):89–95.

    Article  Google Scholar 

  44. Bouxsein ML, Delmas PD. Considerations for development of surrogate endpoints for antifracture efficacy of new treatments in osteoporosis: a perspective. J Bone Miner Res. 2008;23(8):1155–67.

    Article  PubMed  Google Scholar 

  45. Hodgson SF, Watts NB. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis, 2001 Edition, with selected updates for 2003. Endocrine Practice. 2003;9:544–64.

    PubMed  Google Scholar 

  46. Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause 2006 May;13(3):340–367.

  47. Siminoski K, Leslie WD, Frame H, Hodsman A, Josse RG, Khan A, et al. Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J. 2005;56(3):178–88.

    PubMed  Google Scholar 

  48. Eastell R, Hannon RA. Biomarkers of bone health and osteoporosis risk. Proc Nutr Soc. 2008;67(2):157–62.

    Article  PubMed  Google Scholar 

  49. Singer FR, Eyre DR. Using biochemical markers of bone turnover in clinical practice. Cleve Clin J Med. 2008;75(10):739–50.

    Article  PubMed  Google Scholar 

  50. Srivastava AK, Vliet EL, Lewiecki EM, Maricic M, Abdelmalek A, Gluck O, et al. Clinical use of serum and urine bone markers in the management of osteoporosis. Curr Med Res Opin. 2005;21(7):1015–26.

    Article  CAS  PubMed  Google Scholar 

  51. Bonnick SL, Shulman L. Monitoring osteoporosis therapy: bone mineral density, bone turnover markers, or both? Am J Med. 2006;119(4 Suppl 1):S25–31.

    Article  PubMed  Google Scholar 

  52. Miller PD, Hochberg MC, Wehren LE, Ross PD, Wasnich RD. How useful are measures of BMD and bone turnover? Curr Med Res Opin. 2005;21(4):545–54.

    Article  PubMed  Google Scholar 

  53. Lewiecki EM, Richmond B, Miller PD. Uses and misuses of quantitative ultrasonography in managing osteoporosis. Cleve Clin J Med. 2006;73(8):742–52.

    Article  PubMed  Google Scholar 

  54. Krieg MA, Barkmann R, Gonnelli S, Stewart A, Bauer DC, Del Rio BL, et al. Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom. 2008;11(1):163–87.

    Article  PubMed  Google Scholar 

  55. Engelke K, Adams JE, Armbrecht G, Augat P, Bogado CE, Bouxsein ML, et al. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom. 2008;11(1):123–62.

    Article  PubMed  Google Scholar 

  56. Buckley JM, Cheng L, Loo K, Slyfield C, Xu Z. Quantitative computed tomography-based predictions of vertebral strength in anterior bending. Spine. 2007;32(9):1019–27.

    Article  PubMed  Google Scholar 

  57. Buckley JM, Loo K, Motherway J. Comparison of quantitative computed tomography-based measures in predicting vertebral compressive strength. Bone. 2007;40(3):767–74.

    Article  PubMed  Google Scholar 

  58. Keyak JH, Kaneko TS, Tehranzadeh J, Skinner HB. Predicting proximal femoral strength using structural engineering models. Clin Orthop Relat Res. 2005;437:219–28.

    Article  PubMed  Google Scholar 

  59. Keyak JH. Improved prediction of proximal femoral fracture load using nonlinear finite element models. Med Eng Phys. 2001;23(3):165–73.

    Article  CAS  PubMed  Google Scholar 

  60. Majumdar S, Link TM, Augat P, Lin JC, Newitt D, Lane NE, et al. Trabecular bone architecture in the distal radius using magnetic resonance imaging in subjects with fractures of the proximal femur. Magnetic Resonance Science Center and Osteoporosis and Arthritis Research Group. Osteoporos Int. 1999;10(3):231–9.

    Article  CAS  PubMed  Google Scholar 

  61. Boutroy S, Van RB, Sornay-Rendu E, Munoz F, Bouxsein ML, Delmas PD. Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women. J Bone Miner Res. 2008;23(3):392–9.

    Article  PubMed  Google Scholar 

  62. Lotz JC, Cheal EJ, Hayes WC. Fracture prediction for the proximal femur using finite element models: part I—linear analysis. J Biomechan Eng. 1991;113:353–60.

    Article  CAS  Google Scholar 

  63. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254–9.

    CAS  PubMed  Google Scholar 

  64. Kanis JA, WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Osteoporos Int. 1994;4:368–81.

    Article  CAS  PubMed  Google Scholar 

  65. Cranney A, Tugwell P, Wells G, Guyatt G. Systematic reviews of randomized trials in osteoporosis: introduction and methodology. Endocr Rev. 2002;23(4):497–507.

    CAS  Google Scholar 

  66. Mazess R, Chesnut III CH, McClung M, Genant H. Enhanced precision with dual-energy X-ray absorptiometry. Calcif Tissue Int. 1992;51(1):14–7.

    Article  CAS  PubMed  Google Scholar 

  67. Njeh CF, Fuerst T, Hans D, Blake GM, Genant HK. Radiation exposure in bone mineral density assessment. Appl Radiat Isotopes. 1999;50(1):215–36.

    Article  CAS  Google Scholar 

  68. Wasnich RD, Miller PD. Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab. 2000;85(1):231–6.

    Article  CAS  PubMed  Google Scholar 

  69. Cummings SR, Karpf DB, Harris F, Genant HK, Ensrud K, LaCroix AZ, et al. Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med. 2002;112:281–9.

    Article  CAS  PubMed  Google Scholar 

  70. Sarkar S, Mitlak BH, Wong MM, Stock JL, Black DM, Harper KD. Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner Res. 2002;17(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  71. Watts NB, Cooper C, Lindsay R, Eastell R, Manhart MD, Barton IP, et al. Relationship between changes in bone mineral density and vertebral fracture risk associated with risedronate: greater increases in bone mineral density do not relate to greater decreases in fracture risk. J Clin Densitom. 2004;7(3):255–61.

    Article  PubMed  Google Scholar 

  72. Hochberg MC, Greenspan S, Wasnich RD, Miller P, Thompson DE, Ross PD. Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab. 2002;87(4):1586–92.

    Article  CAS  PubMed  Google Scholar 

  73. Delmas PD, Li Z, Cooper C. Relationship between changes in bone mineral density and fracture risk reduction with antiresorptive drugs: some issues with meta-analyses. J Bone Miner Res. 2004;19(2):330–7.

    Article  CAS  PubMed  Google Scholar 

  74. Lewiecki EM, Binkley N, Petak SM. DXA quality matters. J Clin Densitom. 2006;9(4):388–92.

    Article  PubMed  Google Scholar 

  75. Lewiecki EM. Clinical applications of bone density testing for osteoporosis. Minerva Med. 2005;96(5):317–30.

    CAS  PubMed  Google Scholar 

  76. Bonnick SL, Johnston Jr CC, Kleerekoper M, Lindsay R, Miller P, Sherwood L, et al. Importance of precision in bone density measurements. J Clin Densitom. 2001;4(2):105–10.

    Article  CAS  PubMed  Google Scholar 

  77. Shepherd JA, Lu Y, Wilson K, Fuerst T, Genant H, Hangartner TN, et al. Cross-calibration and minimum precision standards for dual-energy X-ray absorptiometry: the 2005 ISCD official positions. J Clin Densitom. 2006;9(1):31–6.

    Article  PubMed  Google Scholar 

  78. Binkley N, Kiebzak GM, Lewiecki EM, Krueger D, Gangnon RE, Miller PD, et al. Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res. 2005;20(2):195–201.

    Article  PubMed  Google Scholar 

  79. Lewiecki EM, Rudolph LA. How common is loss of bone mineral density in elderly clinical practice patients receiving oral bisphosphonate therapy for osteoporosis? J Bone Miner Res. 2002;17 Suppl 2:S367.

    Google Scholar 

  80. Berger C, Langsetmo L, Joseph L, Hanley DA, Davison S, Josse RG, et al. Association between change in Bone Mineral Density (BMD) and fragility fracture in women and men. J Bone Miner Res. 2009;24(2):361–70.

    Article  PubMed  Google Scholar 

  81. Calvo MS, Eyre DR, Gundberg CM. Molecular basis and clinical application of biological markers of bone turnover. Endocr Rev. 1996;17(4):333–68.

    CAS  PubMed  Google Scholar 

  82. Garnero P, Sornay-Rendu E, Chapuy M-C, Delmas PD. Increased bone turnover in late postmenopausal women is a major determinant of osteoporosis. J Bone Miner Res. 1996;11:337–49.

    Article  CAS  PubMed  Google Scholar 

  83. Ross PD, Knowlton W. Rapid bone loss is associated with increased levels of biochemical markers. J Bone Miner Res. 1998;13(2):297–302.

    Article  CAS  PubMed  Google Scholar 

  84. Garnero P, Hausherr E, Chapuy M-C, Marcelli C, Grandjean H, Muller C, et al. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS prospective study. J Bone Miner Res. 1996;11:1531–8.

    Article  CAS  PubMed  Google Scholar 

  85. Garnero P, Sornay-Rendu E, Claustrat B, Delmas PD. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res. 2000;15(8):1526–36.

    Article  CAS  PubMed  Google Scholar 

  86. Gerdhem P, Ivaska KK, Alatalo SL, Halleen JM, Hellman J, Isaksson A, et al. Biochemical markers of bone metabolism and prediction of fracture in elderly women. J Bone Miner Res. 2004;19(3):386–93.

    Article  CAS  PubMed  Google Scholar 

  87. Chen JS, Seibel MJ, Zochling J, March L, Cameron ID, Cumming RG, et al. Calcaneal ultrasound but not bone turnover predicts fractures in vitamin D deficient frail elderly at high risk of falls. Calcif Tissue Int. 2006;79(1):37–42.

    Article  CAS  PubMed  Google Scholar 

  88. Chesnut C, Bell NH, Clark GS, Drinkwater BL, English SC, Johnston CC, et al. Hormone replacement therapy in postmenopausal women: urinary N-telopeptide of type I collagen monitors therapeutic effect and predicts response of bone mineral density. Am J Med. 1997;102:29–37.

    Article  CAS  PubMed  Google Scholar 

  89. Greenspan SL, Parker RA, Ferguson L, Rosen HN, Maitland-Ramsey L, Karpf DB. Early changes in biochemical markers of bone turnover predict the long-term response to alendronate therapy in representative elderly women: a randomized clinical trial. J Bone Miner Res. 1998;13:1431–8.

    Article  CAS  PubMed  Google Scholar 

  90. Eastell R, Barton I, Hannon RA, Chines A, Garnero P, Delmas PD. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res. 2003;18:1051–6.

    Article  CAS  PubMed  Google Scholar 

  91. Bauer DC, Black DM, Garnero P, Hochberg M, Ott S, Orloff J, et al. Change in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: the fracture intervention trial. J Bone Miner Res. 2004;19(8):1250–8.

    Article  PubMed  Google Scholar 

  92. Sarkar S, Reginster JY, Crans GG, ez-Perez A, Pinette KV, Delmas PD. Relationship between changes in biochemical markers of bone turnover and BMD to predict vertebral fracture risk. J Bone Miner Res. 2004;19(3):394–401.

    Article  PubMed  Google Scholar 

  93. Chen P, Satterwhite JH, Licata AA, Lewiecki EM, Sipos AA, Misurski DM, et al. Early changes in biochemical markers of bone formation predict BMD response to teriparatide in postmenopausal women with osteoporosis. J Bone Miner Res. 2005;20(6):962–70.

    Article  CAS  PubMed  Google Scholar 

  94. Hannon R, Eastell R. Preanalytical variability of biochemical markers of bone turnover. Osteoporos Int. 2000;11 Suppl 6:S30–44.

    Article  PubMed  Google Scholar 

  95. Seibel MJ. Biochemical markers of bone turnover: part I: biochemistry and variability. Clin Biochem Rev. 2005;26(4):97–122.

    PubMed  Google Scholar 

  96. Seibel MJ, Lang M, Geilenkeuser WJ. Interlaboratory variation of biochemical markers of bone turnover. Clin Chem. 2001;47(8):1443–50.

    CAS  PubMed  Google Scholar 

  97. Glover SJ, Gall M, Schoenborn-Kellenberger O, Wagener M, Garnero P, Boonen S, et al. Establishing a reference interval for bone turnover markers in 637 healthy, young, premenopausal women from the United Kingdom, France, Belgium, and the United States. J Bone Miner Res. 2009;24(3):389–97.

    Article  PubMed  Google Scholar 

  98. Glover SJ, Garnero P, Naylor K, Rogers A, Eastell R. Establishing a reference range for bone turnover markers in young, healthy women. Bone. 2008;42(4):623–30.

    Article  CAS  PubMed  Google Scholar 

  99. Iki M, Akiba T, Matsumoto T, Nishino H, Kagamimori S, Kagawa Y, et al. Reference database of biochemical markers of bone turnover for the Japanese female population. Japanese Population-based Osteoporosis (JPOS) study. Osteoporos Int. 2004;15(12):981–91.

    Article  CAS  PubMed  Google Scholar 

  100. Miller PD, Baran DT, Bilezikian JP, Greenspan SL, Lindsay R, Riggs BL, et al. Practical clinical application of biochemical markers of bone turnover: consensus of an expert panel. J Clin Densitom. 1999;2(3):323–42.

    Article  CAS  PubMed  Google Scholar 

  101. Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere 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(1):19–26.

    Article  CAS  PubMed  Google Scholar 

  102. Watts NB. Clinical utility of biochemical markers of bone remodeling. Clin Chem. 1999;45:1359–68.

    CAS  PubMed  Google Scholar 

  103. Lewiecki EM, Baim S, Bilezikian JP, Eastell R, LeBoff MS, Miller PD. 2008 Santa Fe Bone Symposium: update on osteoporosis. J Clin Densitom. 2009;12(2):135–57.

    Article  PubMed  Google Scholar 

  104. Clowes JA, Peel NF, Eastell R. The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab. 2004;89(3):1117–23.

    Article  CAS  PubMed  Google Scholar 

  105. Sebba AI. Significance of a decline in bone mineral density while receiving oral bisphosphonate treatment. Clin Ther. 2008;30(3):443–52.

    Article  CAS  PubMed  Google Scholar 

  106. Chapurlat RD, Palermo L, Ramsay P, Cummings SR. Risk of fracture among women who lose bone density during treatment with alendronate. The fracture intervention trial. Osteoporos Int. 2005;16(7):842–8.

    Article  CAS  PubMed  Google Scholar 

  107. Watts NB, Miller PD, Kohlmeier LA, Sebba A, Chen P, Wong M, et al. Vertebral fracture risk is reduced in women who lose femoral neck bone mineral density with teriparatide treatment. J Bone Miner Res 2009;24(6):1125–31.

    Article  CAS  PubMed  Google Scholar 

  108. The Lewin Group. Assessing the costs of performing DXA services in the office-based setting (survey data report prepared for American Association of Clinical Endocrinologists. International Society for Clinical Densitometry, The Endocrine Society, and American College of Rheumatology). The Lewin Group 2007 October 31. Available from: URL: http://www.endo-society.org/publicpolicy/legislative/upload/DXA_Final_Report_from_The_Lewin_Group10_31_07.pdf

  109. Lewiecki EM. Crisis in osteoporosis care. Female Patient. 2009;34:1–2.

    Google Scholar 

  110. Lewiecki EM, Baim S, Siris ES. Osteoporosis care at risk in the United States. Osteoporos Int. 2008;19(11):1505–9.

    Article  CAS  PubMed  Google Scholar 

  111. Kanis JA, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int. 2005;16(3):229–38.

    Article  CAS  PubMed  Google Scholar 

  112. Cummings SR, Palermo L, Browner W, Marcus R, Wallace R, Pearson J, et al. Monitoring osteoporosis therapy with bone densitometry—misleading changes and regression to the mean. JAMA. 2000;283(10):1318–21.

    Article  CAS  PubMed  Google Scholar 

  113. Lenchik L, Watts NB. Regression to the mean: what does it mean? Using bone density results to monitor treatment of osteoporosis. J Clin Densitom. 2001;4(1):1–4.

    Article  CAS  PubMed  Google Scholar 

  114. Bonnick SL. Monitoring osteoporosis therapy with bone densitometry: a vital tool or regression toward mediocrity? J Clin Endocrinol Metab. 2000;85:3493–5.

    Article  CAS  PubMed  Google Scholar 

  115. Marx RE, Cillo Jr JE, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg. 2007;65(12):2397–410.

    Article  PubMed  Google Scholar 

  116. Marx RE. Bisphosphonate-induced osteonecrosis of the jaws: a challenge, a responsibility, and an opportunity. Int J Periodontics Restorative Dent. 2008;28(1):5–6.

    PubMed  Google Scholar 

  117. Sawatari Y, Marx RE. Bisphosphonates and bisphosphonate induced osteonecrosis. Oral Maxillofac Surg Clin North Am. 2007;19(4):487–98.

    Article  PubMed  Google Scholar 

  118. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg. 2008;66(6):1320–1.

    Article  PubMed  Google Scholar 

  119. 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(4):561–74.

    Article  CAS  PubMed  Google Scholar 

  120. Meier C, Seibel MJ, Kraenzlin ME. Use of bone turnover markers in the real world: are we there yet? J Bone Miner Res. 2009;24(3):386–8.

    Article  PubMed  Google Scholar 

  121. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum. 2001;44:1496–503.

    Article  Google Scholar 

  122. Myers ER, Wilson SE. Biomechanics of osteoporosis and vertebral fracture. Spine. 1997;22(24 Suppl):25S–31S.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to E. Michael Lewiecki.

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Lewiecki, E.M. Monitoring pharmacological therapy for osteoporosis. Rev Endocr Metab Disord 11, 261–273 (2010). https://doi.org/10.1007/s11154-010-9126-4

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