Background: Osteoporosis is a debilitating disease characterized by bone micro-architecture
degradation contributing to fragility fractures. Currently, determining bone mineral density (BMD) via
dual-energy X-ray absorptiometry (DXA) is the most reliable form of diagnosing osteoporosis and managing
pharmacological treatment regimens. However, changes in BMD occur slowly (i.e., several
months) and DXA does not reflect the metabolic rate of bone turnover. Alternatively, biochemical bone
turnover markers are metabolic indicators released into serum and/or urine, and their quantity reflects the
metabolic activity of bone. bone turnover markers show a rapid response following antiresorptive drug
administration, and enzyme-linked immunosorbent assays (ELISA) have been established and used in
clinical trials to help assess and predict fracture risk independent of BMD.
Objective: This review highlights various established bone turnover markers that have found utility in
the clinic as reliable and standardized indicators of bone turnover, with attention to those used to assess
efficacy of bisphosphonate drug therapy – particularly in monitoring medication adherence in patients
with postmenopausal osteoporosis.
Results: We posit that the use of urinary bone turnover markers values determined by immunoassay or
ELISA at routine clinic visits might serve as valuable feedback to healthcare professionals and patients
to help monitor the efficacy and adherence of bisphosphonate therapy and disease progression.
Conclusion: Our belief is that when assessed in combination with an algorithm of independent risk
factors, measuring urinary bone turnover markers using a point of care kit may find utility in the osteoporosis
clinic as an accessible, non-invasive and cost-effective alternative for the routine assessment
of efficacy of bisphosphonate therapies.