Clinical Needs In Osteoporosis

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Presentation transcript:

IOF International Osteoporosis Foundation Cooper C Ebeling PR Eastell R Silverman S Vasikaran S

Clinical Needs In Osteoporosis

Bone Remodelling Cycle

Age Dependency Patterns In Women

Classification of BTMs

Attractiveness of BTMs

Limitations of BTMs

Uncontrollable Sources of Pre-analytical Variability

Controllable Sources of Pre-analytical Variability

Seasonal Variability

Diurnal Variation in Urine Dpd

Diurnal Variation in Serum CTX

BTMs Predict Fracture Independently of BMD

The Additive Effects of BTMs and BMD on Fracture Risk

BTMs Predict Fracture Independently of Prior Fracture

Markers of Bone Formation and Prediction of Fracture

Limitations

Limitations (2)

Predictive Capacity of BTMs Attenuates with Time

BTMs in Fracture Risk Algorithms

sCTX and Fracture Prediction in Postmenopausal Women

sP1NP and Fracture Prediction in Postmenopausal Women

Relationship Between Bone Turnover and Bone Loss

Typical BTM Changes After Anti-Resorptive vs Anabolic Therapy

Response of BTMs To Anabolic Therapy (hPTH1-34)

Response of BTMs to Strontium Ranelate

Dose Response of Serum CTX With Ibandronate

Frequency of Administration of an Anti-Resorptive Therapy Daily vs Frequency of Administration of an Anti-Resorptive Therapy Daily vs. monthly risedronate

Route of Administration Determines BTM Response

Wide Variability of Changes in BTM After Therapy

Effects of Discontinuing Alendronate on sCTX and BSAP

Effects of Discontinuing Denosumab on Serum CTX and BSAP

Effect of Denosumab Re-treatment on Serum CTX and BSAP

Baseline sCTX and P1NP Predict Change in BMD with Alendronate or Denosumab Therapy

Changes in BTMs After Treatment Correlate With Fracture Risk Reduction

Percent of Treatment Effect Explained by Bone Turnover Markers

BTM vs BMD Monitoring

Evidence for the Utility of Bone Turnover Markers In Monitoring Osteoporosis Treatment

BMD vs BTMs for Monitoring

BTMs Vary With Age In Premenopausal Women

Reference Intervals For sCTX

Reference Inetrvals For sP1NP

« Drug Holidays »

Algorithm For Drug Holidays

BTMs Could Identify Secondary Osteoporosis

BTMs Could Predict the Response to Therapy

BTMs Could Improve Adherence to Treatment

IOF-IFCC Recommendations

IOF-IFCC Recommendations

sCTX: Reference Standard for Bone Resorption

sP1NP: Reference Standard For Bone Formation

THANK YOU