Fast Five Quiz: Osteoporosis Prevention and Treatment

Herbert S. Diamond, MD


December 10, 2020

Most antiresorptive treatments for osteoporosis generate a decrease in bone turnover that, depending on the drug's potency and route of administration and on the bone marker, reaches a plateau within a few weeks or months. Consequently, individual patients can be monitored with bone markers earlier than with DXA. Monitoring bisphosphonate therapy with bone marker measurement at baseline and at 3 and 6 months can improve compliance with therapy by 20% at 1 year. A decrease greater than 50% and 30% in urinary collagen type 1 cross-linked N-telopeptide (NTX) and serum C-telopeptide of type 1 collagen (CTX), respectively, is indicative of treatment compliance and drug efficacy.

Baseline bone turnover markers are not strong predictors of the response to therapy with antiresorptive drugs, although the change in bone markers is clinically valuable for assessing treatment response.

BMD with DXA is often used in clinical trials to measure treatment efficacy. When patients are receiving potent bisphosphonates, such as alendronate and risedronate, repeating BMD measurement 2 years after initiating therapy will show whether a patient is responding to therapy. A significant increase in BMD at least at the lumbar spine is seen in patients who are responding to therapy. However, such treatments as raloxifene and nasal calcitonin induce much less significant increases in BMD, making DXA inappropriate for therapeutic monitoring.

Learn more about bone markers in osteoporosis.

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