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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

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International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine Position on bone marker standards in osteoporosis

1, 2 / Cyrus Cooper3, 4 / Richard Eastell5 / Andrea Griesmacher6 / Howard A. Morris7 / Tommaso Trenti8 / John A. Kanis9

1Department of Core Clinical Pathology and Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia

2School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia

3MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK

4NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK

5NIHR Bone Biomedical Research Unit, Centre for Biomedical Research, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, England, UK

6Central Institute for Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, Innsbruck, Austria

7School of Pharmacy and Medical Sciences, University of South Australia, Adelaide South Australia, Australia

8Patologia Clinica, Tossicologia e Diagnostica Avanzata, Ospedale Nuovo Sant'Agostino Estense, Dipartimento di Patologia Clinica, Modena, Italy

9Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Beech Hill Road, Sheffield, UK

Corresponding author: Dr. Samuel Vasikaran, Core Clinical Pathology and Biochemistry Department, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6847, Australia Phone: (+61) 8 9224 2453, Fax: (+61) 8 9224 1789

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 49, Issue 8, Pages 1271–1274, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2011.602, May 2011

Publication History

Published Online:


The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on Bone Marker Standards (WG-BMS) has evaluated the clinical potential of bone turnover markers (BTMs) in the prediction of fracture risk and for monitoring treatment. Research evidence suggests that BTMs may provide information on fracture risk independently from BMD, so that fracture risk prediction might be enhanced by their inclusion in assessment algorithms. The potential use of BTMs to predict the response to treatments for osteoporosis in the individual patient is also of great interest. Treatment-induced changes in specific markers account for a substantial proportion of fracture risk reduction. However, there is still a need for stronger evidence on which to base practice in both situations. IOF/IFCC recommends one bone formation marker (serum procollagen type I N propeptide, s-PINP) and one bone resorption marker (serum C-terminal cross-linking telopeptide of type I collagen, s-CTX) to be used as reference markers and measured by standardised assays in observational and intervention studies in order to enlarge the international experience of the application of markers to clinical medicine and to help resolve uncertainties over their clinical use.

Keywords: bone mineral density; bone turnover markers; clinical risk factors; fracture risk; osteoporosis; reference standard

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