Authors' objectives: Bone turnover is the process of bone breakdown and renewal; under normal circumstances, these two parts of the process are balanced to ensure a constant bone density. If this balance is not maintained, bone structure, mass and strength may be altered. Osteoporosis is a disease of bone in which bone mineral density is reduced, as a result of increased bone breakdown and/or reduced bone renewal. Osteoporosis is thought to be responsible for 200,000 fractures every year, with broken wrists, hips and spinal bones the most common. The measurement of products in the blood or urine as a result of either bone breakdown or renewal, can be used to monitor bone turnover. These tests therefore, may be useful in monitoring the response to treatment of bone turnover in patients with osteoporosis. To investigate this, we will undertake a systematic review to determine how well changes in bone turnover markers correlate with reductions in the incidence of fractures in people being treated for osteoporosis, and how the use of bone turnover markers impact on adherence with osteoporosis treatment. The cost-effectiveness of using bone turnover markers to encourage adherence to treatment, and identifying patients who are not adherent will also be investigated.

Authors' recommendations: There was insufficient evidence to inform the choice of which bone turnover marker to use in routine clinical practice to monitor osteoporosis treatment response. The research priority is to identify the most promising treatment–test combinations for evaluation in subsequent, methodologically sound, RCTs. In order to determine whether or not bone turnover marker monitoring improves treatment management decisions, and ultimately impacts on patient outcomes in terms of reduced incidence of fracture, RCTs are required. Given the large number of potential patient population–treatment–test combinations, the most promising combinations would initially need to be identified in order to ensure that any RCTs focus on evaluating those strategies. As a result, the research priority is to identify these promising combinations, by either conducting small variability studies or initiating a patient registry to collect standardised data.

Project Status: Completed

Year Published: 2014

URL for published report: http://www.journalslibrary.nihr.ac.uk/hta/hta18110/#/abstract

URL for additional information: http://www.journalslibrary.nihr.ac.uk/hta/volume-18/issue-11

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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