MAY 30, 2014 11:30 AM PDT

Keynote: Biochemical Markers of Bone Turnover in the Management of Postmenopausal Osteoporosis

  • Distinguished Clinical Professor of Medicine, University of Colorado Health Sciences Center Medical Director Colorado Center for Bone Research

        Dr. Paul D. Miller, FACP, is a world-renowned physician specializing in metabolic bone disease. He is widely considered a leading authority on bone biology, prevention and treatment of metabolic bone disorders, including osteoporosis. Dr. Miller is Medical Director at the Colorado Center for Bone Research in Lakewood, Colo., which is recognized as a top facility for diagnosis and treatment of metabolic bone disease. He is also a Distinguished Clinical Professor of Medicine at the University of Colorado, Health Sciences Center. Dr. Miller is Board Certified in both Internal Medicine and Nephrology (kidney diseases). Dr. Miller's research focuses on the treatment of osteoporosis in postmenopausal women, and he is the principal investigator in a number of clinical trials evaluating the safety and efficacy of current and potential therapies. He is the author and co-author of nearly 300 publications, including original articles, chapters and books. His insights and thought leadership have made him a media resource and sought-after speaker. He lectures extensively to physicians, drug companies and academics who find his comprehension unmatched.    


    Bone turnover markers (BTM) are biological markers of bone remodeling (turnover). The entire skeleton is replaced every 10 years by remodeling, a process constantly going on at different phases throughout the skeleton (Figure 1). The purposes of remodeling are to repair the microcracks that occur in the skeleton with daily mechanical loading.

    From these bone remodeling cavities proteins (BTM) are released into the circulation and can be measured by radioimmunoassay or immunoassay. (Figure 2)

    The clinical evidence is consistent that these markers are useful for:

    1. Determining the rate of bone turnover (high bone turnover is an independent risk factor for osteoporotic fracture) and predicting the rate of bone loss.

    2. Assessing response to osteoporosis treatments (both anti-resorptive as well as anabolic agents). The change in the BTM after the initiation of treatment occurs rapidly-within 3 months of starting therapy and, therefore, provide much earlier information on compliance, and a bone effect than bone mineral density (BMD) which requires 1-2 years to see a measureable change. A change in the BTM also predicts improvements in BMD and predicts fracture risk reduction

    Two large international groups: The International Osteoporosis Foundation-International Federation of Clinical Chemistry and The National Bone Health Alliance-American Association of Clinical Chemistry both have both endorsed, based on evidence, that the preferred BTM for bone formation is the propeptide type I collagen (PINP) and for bone resorption the collagen cross-link, C-telopeptide (CTX).

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