Bone turnover markers reflect the work of the osteoclasts (bone resorption markers) and the osteoblasts (bone formation markers). These can be used to predict fracture risk and rate of bone loss, but such a use has not proven so useful clinically. However, they are very useful for monitoring therapy onset and offset.

Antiresorptive drugs such as bisphosphonates and denosumab cause a large and early decrease on bone resorption and bone formation markers and so provide an early indication of response. Anabolic drugs such as teriparatide cause a large and early increase in bone formation and bone resorption markers and so can provide an early indication of response. During a ‘drug holiday’ bone turnover markers are useful in identifying the offset of response suggesting that treatment should be resumed.

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