EMERGING APPOACH OF BONE REMODELLING INDICES

The field of osteoporosis, especially of primary type, tidily connected with estrogen deprivation and aging, is complex and dynamic. Bone turnover markers (BTM) have been and still are a hot spot on this panorama, because no straight cut lines are found yet. We aim to briefly introduce the current status of BTM, as a short commentary. BTM have a high inter- and intra- individual variation, they are rather expensive for daily practice, they are not necessary to diagnose osteoporosis. Low or normal levels do not necessary mean that a person will not suffer fragility fracture while a higher level is associated with an increased fracture risk. Moreover, BTM seem better players for clinical studies to point out the efficacy of anti-osteoporotic drugs rather than helping each patient’s decision. BTM prematurely detect remodelling variations before DXA. No algorithm or calculation model of fracture prediction has incorporated yet BTM, most probably due to heterogeneity of reports. Traditional BTM are alkaline phosphates, osteocalcin, and collagen- derived fragments. New BTM, that proved useful, are represented by P1NP. Atypical BTM like osteoprotegerin, sclerostin, and serotonin are still far from daily practitioners’ assessment. Regardless classical or modern, the way that BTM represent a reflection of skeleton health is still an emerging subject.