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Roche Bone Markers for an Improved Management of Osteoporosis Patients

The burden of osteoporosis is significant and increasing as the population ages.

Osteoporosis is a silent disease whereby bone metabolism is unbalanced and bone tissue is removed faster than it is replaced. This causes bones to become porous and fragile and increases the risk of fractures. It is estimated that an osteoporotic fracture occurs every 3 seconds and more than 200 million women are affected by osteoporosis worldwide.1 As life expectancy is increasing and the population ages, the proportion of people at risk of osteoporotic fractures is constantly growing too.

Effective osteoporosis treatments are available but challenges exist and may compromise therapy success.

Patients diagnosed with osteoporosis will usually be prescribed a medical treatment to prevent bone loss and osteoporotic fractures along with lifestyle changes.2 The osteoporosis treatments are in most cases highly effective in preventing further bone loss and osteoporotic fractures and can reduce the risk of hip fracture by up to 40%.3 However, challenges exist and might compromise patients’ therapy success:

• Poor adherence and persistence to therapy4

The lack of persistence and adherence to osteoporosis therapy is a common and well recognized problem.4 Poor adherence can result from forgetfulness, concerns about the therapy’s side effects or an inability to see the therapy's benefits. Adherence and persistence are crucial as they have a considerable impact on fracture and mortality risk reduction.5,6

• Sub-optimal response to treatment7,8

Even when patients fully comply, their osteoporosis treatment might be ineffective. A sub-optimal response to treatment can be caused by the existence of secondary osteoporosis due to certain medical conditions or treatments that interfere with bone metabolism, poor intestinal absorption, or an inadequate level of 25-hydroxyvitamin D (25[OH]D) or calcium.

Procollagen type I amino-terminal propeptide (PINP) and carboxy-terminal telopeptide of type I collagen (CTX) can help monitor osteoporosis treatment response 3 months after treatment initiation.9-12

The standard practice to assess treatment response is to do a routine bone mineral density checkup every 24 months as significant changes in bone mineral density occur over many months. This means that it will be 24 months before knowing whether the patient is adhering and effectively responding to the treatment. An earlier assessment of response to treatment would be preferred. 

The good news is that patients don’t need to wait 2 years. A simple blood test can give reassurance after only 3 months. Bone turnover markers (BTM) can be used as an aid in monitoring osteoporosis therapy at a much earlier time point than the most commonly used bone density scan called dual energy x-ray absorptiometry (DXA).9-12 Although many bone markers exist, one bone resorption marker, CTX, and one bone formation marker, PINP, have been recommended by the International Federation for Clinical Chemistry (IFCC) and the International Osteoporosis Foundation (IOF) as reference markers.13 

A complete bone metabolism panel on a single platform for improved patient management.

Roche bone marker assays are important diagnostic aids in the evaluation and management of osteoporosis and other bone-related diseases, providing a more complete picture of bone metabolism than bone mineral densitometry (BMD) alone.

• B-Crosslaps (CTX)
Aid in the assessment of bone resorption rate, monitoring anti-resorptive therapies such as bisphosphonates 

• PINP
Aid in the assessment of bone formation rate, monitoring therapy in patients diagnosed with osteoporosis and Paget's disease

• Osteocalcin
Aid in the assessment of bone turnover, monitoring anti-resorptive therapies in osteoporosis

• Vitamin D
Aid in the assessment of vitamin D sufficiency

• Parathyroid hormone (PTH)
Differential diagnosis of hypercalcemia/hypocalcemia by assessing the secretory activity of the parathyroid glands

References

 

  1. Johnell, O., & Kanis, J. A. (2006). An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis international, 17(12), 1726-1733.
  2. Cosman, F., De Beur, S. J., LeBoff, M. S., Lewiecki, E. M., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis international, 25(10), 2359-2381.
  3. Kanis J.A., Burlet N., Cooper C., et al. (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399.
  4. Modi, A., Sajjan, S., & Gandhi, S. (2014). Challenges in implementing and maintaining osteoporosis therapy. International journal of women’s health 6, 759.
  5. Caro, J.J., Ishak, K.J., Huybrechts, K.F., Raggio, G., & Naujoks, C. (2004). The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporosis International 15(12), 1003-1008.
  6. Center, J.R., Bliuc, D., Nguyen, N.D., Nguyen, T.V., & Eisman, J.A. (2011). Osteoporosis medication and reduced mortality risk in elderly women and men. The Journal of Clinical Endocrinology & Metabolism 96(4), 1006-1014.
  7. Lewiecki, E.M., & Watts, N.B. (2008). Assessing response to osteoporosis therapy. Osteoporosis International 19(10), 1363-1368.
  8. Lewiecki, E.M. (2003). Nonresponders to osteoporosis therapy. Journal of Clinical Densitometry 6(4), 307-314.
  9. Naylor, K., & Eastell, R. (2012). Bone turnover markers: use in osteoporosis. Nature Reviews Rheumatology 8(7), 379.
  10. Delmas, P.D., Eastell, R., Garnero, P., Seibel, M. J., & Stepan, J. (2000). The use of biochemical markers of bone turnover in osteoporosis. Osteoporosis international, 11(18), S2-S17.
  11. Eastell, R., Pigott, T., Gossiel, F., Naylor, K.E., Walsh, J.S., & Peel, N.F. (2018). DIAGNOSIS OF ENDOCRINE DISEASE: Bone turnover markers: are they clinically useful?. European journal of endocrinology 178(1), R19-R31.
  12. Diez-Perez, A., Naylor, K.E., Abrahamsen, B., Agnusdei, D., Brandi, M.L., Cooper, C., & Hadji, P. (2017). International osteoporosis foundation and european calcified tissue society working group. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporosis International, 28(3), 767-774.
  13. Vasikaran, S., Cooper, C., Eastell, R., Griesmacher, A., Morris, H.A., Trenti, T., & Kanis, J. A. (2011). International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clinical chemistry and laboratory medicine 49(8), 1271-1274.