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Monitoring osteoporosis therapy.

Osteoporosis is a prevalent condition that may exist in a silent form, in which increased fracture risk can be detected by measurement of bone mineral density (BMD), or as a symptomatic condition after a fragility fracture has occurred. In October 2004, the Surgeon General of the United States published a lengthy report on osteoporosis (1), which is a must-read for healthcare professionals interested in this disease.

The chapter “Assessing the Risk of Bone Disease and Fracture” discusses many aspects of bone mass measurement, but relegates biochemical markers of bone turnover to the subsection “Looking to the Future: Potential Complements to BMD” (1). In a sense, this designation is appropriate because these markers currently have no “diagnostic” value, whereas the WHO has designated a BMD >2.5 SD below the mean for healthy adults younger than 50 years as diagnostic for osteoporosis even in the absence of a bone fracture.

Considerable evidence exists, however, that biochemical marker data alone can be used to assess fracture risk in older persons and are additive to BMD data with respect to fracture risk prediction. In reality, neither clinical tool is optimal for this purpose. Two recent studies in older populations have pointed out that among individuals who have sustained a fragility fracture, before the fracture only 40%–45% would have been diagnosed with …