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

2. Clinical Needs In Osteoporosis

3. Bone Remodelling Cycle

4. Age Dependency Patterns In Women

5. Classification of BTMs

6. Attractiveness of BTMs

7. Limitations of BTMs

8. Uncontrollable Sources of Pre-analytical Variability

9. Controllable Sources of Pre-analytical Variability

10. Seasonal Variability

11. Diurnal Variation in Urine Dpd

12. Diurnal Variation in Serum CTX

13. BTMs Predict Fracture Independently of BMD

14. The Additive Effects of BTMs and BMD on Fracture Risk

15. BTMs Predict Fracture Independently of Prior Fracture

16. Markers of Bone Formation and Prediction of Fracture

17. Limitations

18. Limitations (2)

19. Predictive Capacity of BTMs Attenuates with Time

20. BTMs in Fracture Risk Algorithms

21. sCTX and Fracture Prediction in Postmenopausal Women

22. sP1NP and Fracture Prediction in Postmenopausal Women

23. Relationship Between Bone Turnover and Bone Loss

24. Typical BTM Changes After Anti-Resorptive vs Anabolic Therapy

25. Response of BTMs To Anabolic Therapy (hPTH1-34)

26. Response of BTMs to Strontium Ranelate

27. Dose Response of Serum CTX With Ibandronate

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

29. Route of Administration Determines BTM Response

30. Wide Variability of Changes in BTM After Therapy

31. Effects of Discontinuing Alendronate on sCTX and BSAP

32. Effects of Discontinuing Denosumab on Serum CTX and BSAP

33. Effect of Denosumab Re-treatment on Serum CTX and BSAP

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

35. Changes in BTMs After Treatment Correlate With Fracture Risk Reduction

36. Percent of Treatment Effect Explained by Bone Turnover Markers

37. BTM vs BMD Monitoring

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

39. BMD vs BTMs for Monitoring

40. BTMs Vary With Age In Premenopausal Women

41. Reference Intervals For sCTX

42. Reference Inetrvals For sP1NP

43. « Drug Holidays »

44. Algorithm For Drug Holidays

45. BTMs Could Identify Secondary Osteoporosis

46. BTMs Could Predict the Response to Therapy

47. BTMs Could Improve Adherence to Treatment

48. IOF-IFCC Recommendations

49. IOF-IFCC Recommendations

50. sCTX: Reference Standard for Bone Resorption

51. sP1NP: Reference Standard For Bone Formation

52. THANK YOU