Monitoring patients on osteoporosis therapy

Abstract

The goal of osteoporosis therapy is fracture risk reduction. Only a limited amount of fracture risk reduction can be explained by increases in bone mineral density (BMD). Reductions in fracture risk occur long before the changes in BMD. However, with antiresorptive agents, bone turnover markers decrease as early as 3 months after initiation of therapy. Studies show that a decrease in bone turnover markers is a better predictor for reduction in fracture risk than increase in BMD. Bone turnover markers can be used as an adjunct to BMD in monitoring patients with osteoporosis. Guidelines suggest that BMD measurements should be performed with central dual energy x-ray absorptiometry at least 1-2 years apart with the same instrument each time, provided that precision studies are carried out. Results should be compared with the least significant change calculated for that particular instrument. There are no guidelines regarding the use of bone turnover markers, but measuring them 3-6 months after initiation of antiresorptive therapy would be appropriate to document that they are within the reference interval for healthy premenopausal women. © 2007 Future Medicine Ltd.