Evidence map›Paper›PMID 40152990›Full record

ReviewOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

Update on the role of bone turnover markers in the diagnosis and management of osteoporosis: a consensus paper from The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), International Osteoporosis Foundation (IOF), and International Federation of Clinical Chemistry and Laboratory Medicine (IFCC).

Harjit Pal Bhattoa, Samuel Vasikaran, Ioulia Trifonidi, Georgia Kapoula, Giovanni Lombardi, Niklas Rye Jørgensen, Richard Pikner, Masakazu Miura, Roland Chapurlat, Mickael Hiligsmann and 27 more

Abstract readReviewConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Review in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
71citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

71 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  9. Intestinal-Bone Axis Mediated byMicroorganisms · 2026
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  12. Marine drugs · 2026
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11 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

37 authors.

Harjit Pal BhattoaDepartment of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Blvd. 98, 4032, Debrecen, Hungary. harjit@med.unideb.hu.ORCID http://orcid.org/0000-0002-4909-0065
Samuel VasikaranPathWest Laboratory Medicine WA, Murdoch, WA6150, Australia.ORCID http://orcid.org/0000-0002-0831-3031
Ioulia TrifonidiClinical Biochemistry Department-KAT General Hospital, Kifissia, Athens, Greece.ORCID http://orcid.org/0000-0002-3999-8459
Georgia KapoulaClinical Biochemistry Department, General Hospital of Lamia, 35100, Lamia, Greece.ORCID http://orcid.org/0000-0002-6714-0812
Giovanni LombardiLaboratory of Experimental Biochemistry, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy.ORCID http://orcid.org/0000-0002-8365-985X
Niklas Rye JørgensenDepartment of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.ORCID http://orcid.org/0000-0001-9624-5210
Richard PiknerDepartment of Clinical Biochemistry and Bone Metabolism, Klatovska Hospital, Klatovy, Czech Republic.ORCID http://orcid.org/0000-0002-0633-8876
Masakazu MiuraFaculty of Pharmaceutical Sciences, Hokuriku University, Kanazawa, Japan.ORCID http://orcid.org/0000-0001-5685-3924
Roland ChapurlatINSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital E Herriot, 69437, Lyon, France.ORCID http://orcid.org/0000-0001-8214-6385
Mickael HiligsmannDepartment of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.ORCID http://orcid.org/0000-0003-4274-9258
Mathias HaarhausDivision of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.ORCID http://orcid.org/0000-0001-8274-6356
Pieter EvenepoelUniversity Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Louvain, Belgium.ORCID http://orcid.org/0000-0002-0797-4321
Hanne Skou JørgensenDepartment of Clinical Medicine - Department of Medicine and Nephrology, Aarhus University, Aarhus, Denmark.ORCID http://orcid.org/0000-0002-0881-2615
Markus HerrmannClinical Institute of Medical and Chemical Diagnostics, Medical University of Graz, Auenbruggerplatz 15 /1, 8036, Graz, Austria.ORCID http://orcid.org/0000-0002-3559-9899
Jean-Marc KaufmanDepartment of Endocrinology, Ghent University Hospital, Ghent, Belgium.ORCID http://orcid.org/0000-0002-1400-6812
Patricia ClarkClinical Epidemiology Unit, Faculty of Medicina UNAM, Hospital Infantil Federico Gómez, Mexico City, Mexico.ORCID http://orcid.org/0000-0001-7981-5357
Şansın TuzunDepartment of Physical Medicine and Rehabilitation, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.ORCID http://orcid.org/0000-0002-3300-2286
Nasser Al-DaghriBiochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia.ORCID http://orcid.org/0000-0001-5472-1725
Stuart SilvermanCedars-Sinai Medical Center, OMC Clinical Research Center, Beverly Hills, CA, 90211, USA.ORCID http://orcid.org/0000-0002-5313-1018
Majed S AlokailBiochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia.
Sif OrmarsdóttirIcelandic Medicines Agency, Vínlandsleið 14, 113, Reykjavík, Iceland.
María Concepción Prieto YerroSpanish Agency for Medicines and Medical Devices, Madrid, Spain.
Radmila MatijevicFaculty of Medicine, University of Novi Sad, Novi Sad, Serbia.ORCID http://orcid.org/0000-0002-4993-9399
Andrea LaslopScientific Office, Austrian Medicines and Medical Devices Agency, Vienna, Austria.ORCID http://orcid.org/0009-0009-2707-3959
Mario Miguel Coelho da Silva RosaCentro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.ORCID http://orcid.org/0000-0003-3158-2106
Leith ZakraouiUniversity of Tunis El Manar, Tunis, Tunisia.ORCID http://orcid.org/0000-0001-9276-5892
Nansa BurletDivision d'Epidémiologie, Santé Publique Et Economie de La Santé, Université de Liège, Liège, Belgium.
Eugene McCloskeyDivision of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK.ORCID http://orcid.org/0000-0003-0177-8140
Nicholas C HarveyMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.ORCID http://orcid.org/0000-0002-8194-2512
Régis P RadermeckerCHU de Liège and Centre de Recherche Intégré Sur Les Médicaments (CIRM), Department of Clinical Pharmacology, University of Liège, Domaine du Sart-Tilman, B-4000, Liège, Belgium.ORCID http://orcid.org/0000-0002-2866-8171
Maria FusaroInstitute of Clinical Physiology, 56124, Pisa and Department of Medicine, National Research Council, University of Padova, Padua, Italy.ORCID http://orcid.org/0000-0001-9478-4851
Carla TorreFaculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.ORCID http://orcid.org/0000-0002-5542-9993
John A KanisCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.ORCID http://orcid.org/0000-0002-3129-4326
René RizzoliGeneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.ORCID http://orcid.org/0000-0002-1537-422X
Jean-Yves ReginsterBiochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia.ORCID http://orcid.org/0000-0001-6290-752X
Konstantinos MakrisClinical Biochemistry Department-KAT General Hospital, Kifissia, Athens, Greece.ORCID http://orcid.org/0000-0002-7896-9028
Etienne CavalierCHU de Liège and Centre de Recherche Intégré Sur Les Médicaments (CIRM), Department of Clinical Chemistry, University of Liège, Domaine du Sart-Tilman, B-4000, Liège, Belgium.ORCID http://orcid.org/0000-0003-0947-2226

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) have proposed procollagen type I N propeptide (PINP) and β isomerized C-terminal telopeptide of type I collagen (β-CTX-I) as reference bone turnover markers (BTMs) for osteoporosis. This report examines the published literature since the 2011 IOF-IFCC position paper in order to determine the clinical potential of the reference BTMs and newer markers for the prediction of fracture risk and monitoring the treatment of osteoporosis.

methodsEvidence for the relationship between BTMs and subsequent fractures was gathered from prospective studies through literature review of the Medline database from years 2011 to May 2024. The impact of treatment on BTMs was also studied by examining publications in that period. Studies of the accuracy of BTMs in the assessment of bone turnover in the setting of advanced chronic kidney disease were also examined.

resultsIncreased BTM concentrations are associated with higher fracture risk in postmenopausal women. PINP and β-CTX-I measured in blood are associated with fracture risk but their interaction with other risk factors has not been sufficiently studied limiting their incorporation into fracture risk algorithms. Treatment-induced changes in PINP and β-CTX-I account for a substantial proportion of fracture risk reduction and are useful for improving adherence; they are recommended for inclusion in studies to examine adherence in individual patients. However, total PINP (tPINP) and β-CTX-I may be elevated in CKD due to renal retention. Bone alkaline phosphatase (BALP), intact PINP (iPINP), and tartrate resistant acid phosphatase 5b (TRACP5b) show the most promise in discriminating high and low turnover bone diseases in patients with advanced CKD and for predicting fracture risk, monitoring treatment response, and assessing the risk of treatment-related complications.

conclusionWe re-affirm the use of serum/plasma tPINP and plasma β-CTX-I as reference BTMs with appropriate patient preparation and sample handling and measurement by standardized/harmonized assays in clinical studies to accumulate further data, and for monitoring treatment of osteoporosis in the setting of normal renal function in clinical practice. BALP and TRACP5b, measured by standardized assays, are recommended as reference BTMs for CKD-associated osteoporosis and should be included in observational and intervention studies to ascertain their utility for risk-evaluation, treatment initiation, and assessment of treatment response in CKD-associated osteoporosis.

Indexed as

Bone RemodelingOsteoporosisBiomarkersBone Density Conservation AgentsCollagen Type IConsensusHumansOsteoporotic FracturesPeptide FragmentsPeptidesProcollagenRisk AssessmentBiomarkersBone Density Conservation AgentsCollagen Type Icollagen type I trimeric cross-linked peptidePeptide FragmentsPeptidesProcollagenprocollagen Type I N-terminal peptideBALPBone status indicesBone turnover markersPINPTRACP5bβ-CTX-I

Identifiers

PMID40152990
PMCPMC12064614

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