Bone Turnover Markers

Throughout the span of a lifetime, your bones will continuously grow and regenerate. Even after we stop growing vertically our bones continuously break down and rebuild themselves. The entire skeleton will be turned over during the course 5 -10 years depending on multiple factors. 

 

In osteoporosis an imbalance of bone breakdown and bone rebuilding has existed for years. Finding WHY they are imbalanced is CRITICAL to stopping bone loss and reversing osteoporosis. Measuring how quickly you are losing bone is an important part of this process. DEXA scans are one way to do this but highly flawed as we write about here

 

It can take years to see a change in DEXA scan results. Even if the study is done well and you are seeing a difference in bone quantity (density) it doesn’t mean you are seeing true improvement in bone quality (strength). The body can tell us if we are making progress. You just have to know where to look. 

Bone Turnover Markers

Bone turnover markers (BTMs) can be obtained through blood or urine tests. We prefer blood tests for the most accurate and updated markers of bone remodeling. 

 

Bone remodeling is a recurring process that is aided by two different cells called osteoclast and osteoblasts. Osteoclasts are specialized cells that absorb and remove bone, whereas osteoblasts are cells that produce what is necessary for bone formation. 

 

When monitoring bone turnover markers, we are looking for perfect harmony between bone resorption and bone formation. Monitoring these labs during treatment can tell us if we are successfully making progress! Using blood tests rather than imaging studies has many advantages: 

 

  • Noninvasive
  • Easily repeated
  • Demonstrates what is happening in the ENTIRE system
  • Relatively inexpensive

 

There are two tests that we obtain at regular intervals to identify what’s happening with your bone turnover. 

 

Intact N-Terminal Propeptide (P1NP)

The first BTM we look for is, Intact N-Terminal Propeptide of Type 1 Procollagen, also known as, P1NP. As the name suggests the test is looking for the components of type 1 collage. This Collagen is created by osteoblasts as they lay the foundation of bone. The higher the P1NP in the blood, the higher occurrence of bone formation. 

 

P1NP is considered to be the most sensitive marker for monitoring bone formation. Monitoring levels of P1NP can tell us if your body has stepped up its bone rebuilding efforts. Unfortunately, the biomarker is not frequently ordered for patients. 

 C-Telopeptide (CTX)

C-Telopeptide is another marker used to measure bone turnover. CTX measures the rate of bone breakdown and is therefore a great biomarker to monitor how quickly bone is being lost.  

Risk Factor Evidence: 

The list of risk factors for osteoporosis long but some of the most commonly discussed are: 

  • Age
  • Sex
  • Ethnicity
  • Menopause status
  • Lifestyle

 

The biggest challenge with these is that they are vague and difficult to make recommendations from. How bad does a lifestyle need to be before someone should be screened for osteoporosis. How do we reconcile that the DEXA test is highly flawed? 

 

Testing BTMs may be part of the answer. There is more evidence supporting the fact that a patient who either has a high CTX or a low P1NP may be at higher risk for experiencing bone fractures, even without having a formal diagnosis of osteoporosis. The use of these tests for screening has been recommended by the International and National Osteoporosis Foundations but little has changed in clinical practice. As more recent clinical studies validate the use of these markers for screening we will continue to use them to optimize our patients bone health and validate our approach. 

Final Thoughts:

Osteoporosis is referred to as a “silent disease” and oftentimes you won’t know you have osteoporosis until you experience a broken bone. BTMs are just a few of the tools we use to monitor treatment and verify that we are successfully stopping your bone loss and improving your bone health. 

 

At Optimal Bone Health we offer a personalized approach to improving your health. Our unique approach harnesses genetics, extensive blood and functional testing to identify WHY you are losing bone and create a plan to stop your bone loss. 

 If you are ready to optimize your life or know someone that can benefit from the support we offer, don’t wait any longer- call us at (828) 552-5515 or email hello@ohhmd.com today.

Doug Lucas
Author: Doug Lucas

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