Should serial assessment of bone turnover markers be included in fracture risk calculation in elderly women?

Abstract

Measurement of BMD is a key factor in calculating the risk of osteoporotic fractures. In this Practice Point commentary, I discuss the clinical implications of a Swedish population-based longitudinal observation study that examined the association between BMD and levels of bone turnover markers (BTMs) measured at inclusion and at 1, 3 and 5 year follow-up in 573 women aged 75 years. Baseline BTM levels showed weak correlations with total body bone loss and femoral neck bone loss over 5 years. The correlations were strengthened when the mean of the four serial BTM measurements were used. Of the seven BTMs examined, serum C-terminal cross-linked telopeptide of type I collagen was the best predictor of bone loss. In addition to BMD and clinical risk factors, BTM measurement with standardized sample collection may be useful for management decisions, especially in patients with borderline fracture risk, and could help to identify those at risk of accelerated bone loss.