Fast Five Quiz: Assessment of Fracture Risk in Osteoporosis

Herbert S. Diamond, MD


November 23, 2020

The combination of BMD and bone turnover measurement, such as C-telopeptide of type 1 collagen (CTX) or DPD, can identify women at much higher risk for hip fracture. Urinary and serum CTX and urinary free DPD above the normal premenopausal range were consistently associated with a twofold higher risk for hip, vertebral, and other fractures over 1.8-5 years.

Alkaline phosphatase is a marker of bone metabolism, but changes in its bone-specific levels can lag by several weeks. After starting antiresorptive therapy, suppression can be observed with resorption markers as the coupling process is normalized.

Serum osteocalcin is a marker of osteoblast function and correlates with the rate of bone formation. However, heterogeneity of osteocalcin fragments in the serum limits the usefulness of this marker.

A study found an inverse relationship between the quartile of urinary collagen type 1 cross-linked N-telopeptide excretion and mean BMD, but the results were not consistent. Furthermore, there is substantial overlap between the values of healthy persons and patients with osteoporosis.

Learn more about bone formation and bone turnover markers.


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