Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis

  • Lee, Jehoon (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea) ;
  • Samuel Vasikaran (Department of Core Clinical Pathology and Biochemistry, PathWest-Royal Perth Hospital)
  • Published : 2012.03.01
⟨ Previous Next ⟩

Abstract

Osteoporosis is a major health problem worldwide, and is projected to increase exponentially due to the aging of the population. The absolute fracture risk in individual subjects is calculated by the use of algorithms which include bone mineral density (BMD), age, gender, history of prior fracture and other risk factors. This review describes the laboratory investigations into osteoporosis which include serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone. Parathyroid hormone (PTH) is measured in patients with abnormal serum calcium to determine its cause. Other laboratory investigations such as thyroid function testing, screening for multiple myeloma, and screening for Cushing's syndrome, are performed if indicated. Measurement of bone turnover markers (BTMs) is currently not included in algorithms for fracture risk calculations due to the lack of data. However, BTMs may be useful for monitoring osteoporosis treatment. Further studies of the reference BTMs serum carboxy terminal telopeptide of collagen type I (s-CTX) and serum procollagen type I N-terminal propeptide (s-PINP) in fracture risk prediction and in monitoring various treatments for osteoporosis may help expedite their inclusion in routine clinical practice.

Keywords

References

  1. Consensus Development Conference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993;94:646-50. https://doi.org/10.1016/0002-9343(93)90218-E
  2. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N. A reference standard for the description of osteoporosis. Bone 2008;42:467-75. https://doi.org/10.1016/j.bone.2007.11.001
  3. Lim S, Koo BK, Lee EJ, Park JH, Kim MH, Shin KH, et al. Incidence of hip fractures in Korea. J Bone Miner Metab 2008;26:400-5.
  4. Moon YW, Yoon BK, Min YK, Chang MJ, Jung SM, Lim SJ, et al. Mortality, second fracture, and functional recovery after hip fracture surgery in elderly Koreans. Korean J Bone Metab 2008;15:41-7.
  5. Lee SR, Kim SR, Chung KH, Ko DO, Cho SH, Ha YC, et al. Mortality and activity after hip fracture: a prospective study. J Korean Orthop Assoc 2005;40:423-7. https://doi.org/10.4055/jkoa.2005.40.4.423
  6. Kho DH, Kim KH, Shin JY, Lee JH, Kim DH. Postoperative mortality rate of hip fracture in elderly patients. J Korean Fract Soc 2006;19:117-21. https://doi.org/10.12671/jkfs.2006.19.2.117
  7. Statistics Korea (https://www.index.go.kr/egams/stts/jsp/potal/stts/PO_STTS_IdxMain.jsp?idx_cd=1010&bbs=INDX_001) (Updated on Dec 2011)
  8. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 2011;22:1277-88. https://doi.org/10.1007/s00198-011-1601-6
  9. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992;2:285-9. https://doi.org/10.1007/BF01623184
  10. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:385-97. https://doi.org/10.1007/s00198-007-0543-5
  11. Lee DY, Lim SJ, Moon YW, Min YK, Choi D, Yoon BK, Park YS. Determination of an applicable FRAX model in Korean women. J Korean Med Sci 2010;25:1657-60. https://doi.org/10.3346/jkms.2010.25.11.1657
  12. Tromp AM, Ooms ME, Popp-Snijders C, Roos JC, Lips P. Predictors of fractures in elderly women. Osteoporos Int 2000;11:134-40. https://doi.org/10.1007/PL00004174
  13. Ross PD, Kress BC, Parson RE, Wasnich RD, Armour KA, Mizrahi IA. Serum bone alkaline phosphatase and calcaneus bone density predict fractures: a prospective study. Osteoporos Int 2000;11:76-82. https://doi.org/10.1007/s001980050009
  14. van Daele PL, Seibel MJ, Burger H, Hofman A, Grobbee DE, van Leeuwen JP, et al. Case-control analysis of bone resorption markers, disability, and hip fracture risk: the Rotterdam study. BMJ 1996;312:482-3. https://doi.org/10.1136/bmj.312.7029.482
  15. Chapurlat RD, Garnero P, Breart G, Meunier PJ, Delmas PD. Serum type I collagen breakdown product (serum CTX) predicts hip fracture risk in elderly women: the EPIDOS study. Bone 2000;27:283-6. https://doi.org/10.1016/S8756-3282(00)00325-2
  16. Garnero P, Sornay-Rendu E, Claustrat B, Delmas PD. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY Study. J Bone Miner Res 2000;15:1526-36. https://doi.org/10.1359/jbmr.2000.15.8.1526
  17. Greenfield DM, Hannon RA, Eastell R. The association between bone turnover and fracture risk: The Sheffield Osteoporosis study. In: Eastell R, Baumann M, Hoyle N, Wieczorek L, eds. Bone markers - biochemical and clinical perspectives. Cachan: Lavoisier, 2001;225-6.
  18. Garnero P, Cloos P, Sornay-Rendu E, Qvist P, Delmas PD. Type I collagen racemization and isomerization and the risk of fracture in postmenopausal women: the OFELY prospective study. J Bone Miner Res 2002;17:826-33. https://doi.org/10.1359/jbmr.2002.17.5.826
  19. Meier C, Nguyen TV, Center JR, Seibel MJ, Eisman JA. Bone resorption and osteoporotic fractures in elderly men: the dubbo osteoporosis epidemiology study. J Bone Miner Res 2005;20:579-87.
  20. Bauer DC, Garnero P, Harrison SL, Cauley JA, Eastell R, Ensrud KE, et al. Biochemical markers of bone turnover, hip bone loss, and fracture in older men: the MrOS study. J Bone Miner Res 2009;24:2032-8. https://doi.org/10.1359/jbmr.090526
  21. Vasikaran S, Eastell R, Bruyere O, Foldes AJ, Garnero P, Griesmacher A, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 2011;22:391-420. https://doi.org/10.1007/s00198-010-1501-1
  22. Veitch SW, Findlay SC, Hamer AJ, Blumsohn A, Eastell R, Ingle BM. Changes in bone mass and bone turnover following tibial shaft fracture. Osteoporos Int 2006;17:364-72. https://doi.org/10.1007/s00198-005-2025-y
  23. Ingle BM, Hay SM, Bottjer HM, Eastell R. Changes in bone mass and bone turnover following ankle fracture. Osteoporos Int 1999;10:408-15. https://doi.org/10.1007/s001980050247
  24. Lane NE and Lukert B. The science and therapy of glucocorticoid-induced bone loss. Endocrinol Metab Clin North Am 1998;27:465-83. https://doi.org/10.1016/S0889-8529(05)70017-7
  25. Deodhar AA and Woolf AD. Bone mass measurement and bone metabolism in rheumatoid arthritis: a review. Br J Rheumatol 1996;35:309-22. https://doi.org/10.1093/rheumatology/35.4.309
  26. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men (RACGP) http://www.racgp.org. au/guidelines/musculoskeletaldiseases/osteoporosis (Updated on Feb 2010)
  27. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011;96:53-8. https://doi.org/10.1210/jc.2010-2704
  28. Glendenning P, Taranto M, Noble JM, Musk AA, Hammond C, Goldswain PR, et al. Current assays overestimate 25-hydroxyvitamin D3 and underestimate 25-hydroxyvitamin D2 compared with HPLC: need for assay-specific decision limits and metabolite-specific assays. Ann Clin Biochem 2006;43:23-30. https://doi.org/10.1258/000456306775141650
  29. Glendenning P, Laffer LL, Weber HK, Musk AA, Vasikaran SD. Parathyroid hormone is more stable in EDTA plasma than in serum. Clin Chem 2002;48:766-7.
  30. Chung SH, Kim TH, Lee HH. Relationship between Vitamin D level and bone mineral density in postmenopausal women from Bucheon area. J Korean Society Osteoporos 2009;7:198-202.
  31. Kim H,Ku SY, Kim SH, Choi YM, Moon SY, Kim JG. A study on vitamin D insufficiency in postmenopausal Korean women. J Korean Society Osteoporos 2003;1:12-21.
  32. Park HM. Kim JG. Choi WH, Lim SK. Kim GS. The vitamin D nutritional status of postmenopausal women in Korea. Korean J Bone Metab 2003;10:47-55.
  33. So JS and Park HM. Relationship between parathyroid hormone, vitamin D and bone turnover markers in Korean postmenopausal women. Korean J Obstet Gynecol 2004;47:153-60.
  34. Brown JP, Albert C, Nassar BA, Adachi JD, Cole D, Davison KS, et al. Bone turnover markers in the management of postmenopausal osteoporosis. Clin Biochem 2009;42:929-42. https://doi.org/10.1016/j.clinbiochem.2009.04.001
  35. Koivula MK, Ruotsalainen V, Bjorkman M, Nurmenniemi S, Ikaheimo R, Savolainen K, et al. Difference between total and intact assays for N-terminal propeptide of type I procollagen reflects degradation of pN-collagen rather than denaturation of intact propeptide. Ann Clin Biochem 2010;47:67-71 https://doi.org/10.1258/acb.2009.009110
  36. Marin L, Koivula MK, Jukkola-Vuorinen A, Leino A, Risteli J. Comparison of total and intact aminoterminal propeptide of type I procollagen assays in patients with breast cancer with or without bone metastases. Ann Clin Biochem 2011;48:447-51. https://doi.org/10.1258/acb.2011.011040
  37. Douglas DL, Duckworth T, Russell RG, Kanis JA, Preston CJ, Preston FE, et al. Effect of dichloromethylene diphosphonate in Paget's disease of bone and in hypercalcaemia due to primary hyperparathyroidism or malignant disease. Lancet 1980;1:1043-7.
  38. Fraser WD, Logue FC, Gallacher SJ, O'Reilly DS, Beastall GH, Ralston SH, et al. Direct and indirect assessment of the parathyroid hormone response to pamidronate therapy in Paget's disease of bone and hypercalcaemia of malignancy. Bone Miner 1991;12:113-21. https://doi.org/10.1016/0169-6009(91)90040-7
  39. Chesnut CH 3rd and Harris ST. Short-term effect of alendronate on bone mass and bone remodeling in postmenopausal women. Osteoporosis Int 1993;3(S3):S17-9. https://doi.org/10.1007/BF01623003
  40. Maalouf NM, Heller HJ, Odvina CV, Kim PJ, Sakhaee K. Bisphosphonate- induced hypocalcemia: report of 3 cases and review of literature. Endocr Pract 2006;12:48-53. https://doi.org/10.4158/EP.12.1.48
  41. McCloskey EV, Yates AJ, Gray RE, Hamdy NA, Galloway J, Kanis JA. Diphosphonates and phosphate homeostasis in man. Clin Sci (Lond) 1988; 74:607-12. https://doi.org/10.1042/cs0740607
  42. Vasikaran SD, O'Doherty DP, McCloskey EV, Gertz B, Kahn S, Kanis JA. The effect of alendronate on renal tubular reabsorption of phosphate. Bone Miner 1994;27:51-6. https://doi.org/10.1016/S0169-6009(08)80186-9
  43. Jodrell DI, Iveson TJ, Smith IE.Symptomatic hypocalcaemia after treatment with high-dose aminohydroxypropylidene diphosphonate. Lancet 1987;1:622.
  44. Chong G, Hoang T, Davis ID. Symptomatic hypocalcaemia following intravenous pamidronate in cancer patients. Aust N Z J Med 1999;29:96-7. https://doi.org/10.1111/j.1445-5994.1999.tb01601.x
  45. Garnero P, Shih WJ, Gineyts E, Karpf DB, Delmas PD. Comparison of new biochemical markers of bone turnover in late postmenopausal osteoporotic women in response to alendronate treatment. J Clin Endocrinol Metab 1994;79:1693-700. https://doi.org/10.1210/jc.79.6.1693
  46. Schlosser K and Scigalla P. Biochemical markers as surrogates in clinical trials in patients with metastatic bone disease and osteoporosis. Scand J Clin Lab Invest Suppl 1997;227:21-8.
  47. Braga de Castro Machado A, Hannon R, Eastell R. Monitoring alendronate therapy for osteoporosis. J Bone Miner Res 1999;14:602-8. https://doi.org/10.1359/jbmr.1999.14.4.602
  48. Bell NH, Bilezikian JP, Bone HG 3rd, Kaur A, Maragoto A, Santora AC. Alendronate increases bone mass and reduces bone markers in postmenopausal African-American women. J Clin Endocrinol Metab 2002; 87:2792-7. https://doi.org/10.1210/jc.87.6.2792
  49. Greenspan SL, Parker RA, Ferguson L, Rosen HN, Maitland-Ramsey L, Karpf DB. Early changes in biochemical markers of bone turnover predict the long-term response to alendronate therapy in representative elderly women: a randomized clinical trial. J Bone Miner Res 1998;13: 1431-8. https://doi.org/10.1359/jbmr.1998.13.9.1431
  50. Garnero P, Gineyts E, Arbault P, Christiansen C, Delmas PD. Different effects of bisphosphonate and estrogen therapy on free and peptidebound bone cross-links excretion. J Bone Miner Res 1995;10:641-9.
  51. Rosen HN, Dresner-Pollak R, Moses AC, Rosenblatt M, Zeind AJ, Clemens JD, et al. Specificity of urinary excretion of cross-linked N-telopeptides of type I collagen as a marker of bone turnover. Calcif Tissue Int 1994;54:26-9. https://doi.org/10.1007/BF00316285
  52. Rosen HN, Moses AC, Garber J, Ross DS, Lee SL, Greenspan SL. Utility of biochemical markers of bone turnover in the follow-up of patients treated with bisphosphonates. Calcif Tissue Int 1998;63:363-8. https://doi.org/10.1007/s002239900541
  53. McClung MR, Lewiecki EM, Cohen SB, Bolognese MA, Woodson GC, Moffett AH, et al. Denosumab in postmenopausal women with low bone mineral density. N Engl J Med 2006;354:821-31. https://doi.org/10.1056/NEJMoa044459
  54. Rosen CJ, Hochberg MC, Bonnick SL, McClung M, Miller P, Broy S, et al. Treatment with once-weekly alendronate 70 mg compared with onceweekly risedronate 35 mg in women with postmenopausal osteoporosis: a randomized double-blind study. J Bone Miner Res 2005;20:141-51. https://doi.org/10.1359/JBMR.040920
  55. McClung MR, San Martin J, Miller PD, Civitelli R, Bandeira F, Omizo M, et al. Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass. Arch Intern Med 2005;165:1762-8. https://doi.org/10.1001/archinte.165.15.1762
  56. Body JJ, Gaich GA, Scheele WH, Kulkarni PM, Miller PD, Peretz A, et al. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 2002;87:4528-35. https://doi.org/10.1210/jc.2002-020334
  57. Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004;350:459- 68. https://doi.org/10.1056/NEJMoa022436
  58. Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, et al. Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club. Int J Clin Pract 2009;63:19-26.
  59. Riggs BL, Melton LJ 3rd, O'Fallon WM. Drug therapy for vertebral fractures in osteoporosis: evidence that decreases in bone turnover and increases in bone mass both determine antifracture efficacy. Bone 1996;18(S3):197S-201S. https://doi.org/10.1016/8756-3282(95)00502-1
  60. Delmas PD and Seeman E. Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti-resorptive therapy. Bone 2004;34:599-604. https://doi.org/10.1016/j.bone.2003.12.022
  61. Delmas PD. Markers of bone turnover for monitoring treatment of osteoporosis with antiresorptive drugs. Osteoporos Int 2000;11(S6):S66-76. https://doi.org/10.1007/s001980070007
  62. Hannon R and Eastell R. Preanalytical variability of biochemical markers of bone turnover. Osteoporos Int 2000;11 (S6):S30-44. https://doi.org/10.1007/s001980070004
  63. Eastell R, Krege JH, Chen P, Glass EV, Reginster JY. Development of an algorithm for using PINP to monitor treatment of patients with teriparatide. Curr Med Res Opin 2006;22:61-6. https://doi.org/10.1185/030079905X75096

Cited by

  1. Impact of occupational health hazards on serum markers of bone formation in spray painters of Chennai region in Tamil Nadu vol.16, pp.2, 2012, https://doi.org/10.4103/0019-5278.107084
  2. Impact of occupational health hazards on serum markers of bone formation in spray painters of Chennai region in Tamil Nadu vol.16, pp.2, 2012, https://doi.org/10.4103/0019-5278.107084
  3. Measurement of Serum Levels of 25-Hydroxyvitamin D3and 25-Hydroxyvitamin D2Using Diels-Alder Derivatization and Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry vol.2, pp.4, 2012, https://doi.org/10.3343/lmo.2012.2.4.188
  4. Frax score calculations in postmenopausal women with subclinical hypothyroidism vol.12, pp.3, 2013, https://doi.org/10.1007/bf03401309
  5. Reference intervals for serum osteocalcin concentrations in adult men and women from the study of health in Pomerania vol.13, pp.None, 2013, https://doi.org/10.1186/1472-6823-13-11
  6. The clinical utility of bone marker measurements in osteoporosis vol.11, pp.None, 2013, https://doi.org/10.1186/1479-5876-11-201
  7. Development and validation of osteoporosis risk-assessment model for Korean postmenopausal women vol.31, pp.4, 2013, https://doi.org/10.1007/s00774-013-0426-0
  8. Cyclic variations of bone resorption mediators and markers in the different phases of the menstrual cycle vol.31, pp.4, 2012, https://doi.org/10.1007/s00774-013-0430-4
  9. Biochemical markers for assessment of calcium economy and bone metabolism: application in clinical trials from pharmaceutical agents to nutritional products vol.27, pp.2, 2012, https://doi.org/10.1017/s0954422414000183
  10. Establishing reference intervals for bone turnover markers in healthy postmenopausal women in a nonfasting state vol.3, pp.None, 2014, https://doi.org/10.1038/bonekey.2014.68
  11. Osteoporosis Prevention, Screening, and Treatment: A Review vol.23, pp.7, 2012, https://doi.org/10.1089/jwh.2013.4611
  12. Sclerostin in Institutionalized Elderly Women: Associations with Quantitative Bone Ultrasound, Bone Turnover, Fractures, and Mortality vol.62, pp.6, 2012, https://doi.org/10.1111/jgs.12791
  13. Bone markers and osteoporosis therapy vol.58, pp.5, 2014, https://doi.org/10.1590/0004-2730000003384
  14. Chinese Bone Turnover Marker Study: Reference Ranges for C-Terminal Telopeptide of Type I Collagen and Procollagen I N-Terminal Peptide by Age and Gender vol.9, pp.8, 2012, https://doi.org/10.1371/journal.pone.0103841
  15. Short-Term Isoflavone Intervention in the Treatment of Severe Vasomotor Symptoms after Surgical Menopause: A Case Report and Literature Review vol.2015, pp.None, 2015, https://doi.org/10.1155/2015/962740
  16. The role of enteric hormone GLP-2 in the response of bone markers to a mixed meal in postmenopausal women with type 2 diabetes mellitus vol.7, pp.None, 2012, https://doi.org/10.1186/s13098-015-0006-7
  17. The neuropeptide Y-ergic system: potential therapeutic target against bone loss with obesity treatments vol.10, pp.2, 2015, https://doi.org/10.1586/17446651.2015.1001741
  18. C-telopeptide of type I collagen (CTX-1) in premenopausal Egyptian women with fibromyalgia syndrome vol.42, pp.2, 2012, https://doi.org/10.4103/1110-161x.157867
  19. Can sleep apnea be a secondary cause of osteoporosis in young people? vol.13, pp.2, 2012, https://doi.org/10.1111/sbr.12106
  20. Effectiveness of combined salmon calcitonin and aspirin therapy for osteoporosis in ovariectomized rats vol.12, pp.2, 2012, https://doi.org/10.3892/mmr.2015.3637
  21. In Situ Sensor Advancements for Osteoporosis Prevention, Diagnosis, and Treatment vol.14, pp.6, 2016, https://doi.org/10.1007/s11914-016-0339-7
  22. Osteoporose em 12 questões vol.11, pp.2, 2016, https://doi.org/10.1016/j.rpedm.2016.02.010
  23. Moving toward a prevention strategy for osteoporosis by giving a voice to a silent disease vol.2, pp.None, 2012, https://doi.org/10.1186/s40695-016-0016-0
  24. Effect of Intravenous Glucose Tolerance Test on Bone Turnover Markers in Adults with Normal Glucose Tolerance vol.22, pp.None, 2016, https://doi.org/10.12659/msm.896469
  25. Natural Products from Chinese Medicines with Potential Benefits to Bone Health vol.21, pp.3, 2012, https://doi.org/10.3390/molecules21030239
  26. Development and Validation of Osteoporosis Risk-Assessment Model for Korean Men vol.57, pp.1, 2012, https://doi.org/10.3349/ymj.2016.57.1.187
  27. Assessment of vitamin D status and serum CrossLaps levels in adults with primary lactose malabsorption vol.70, pp.9, 2012, https://doi.org/10.1038/ejcn.2016.66
  28. Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity vol.28, pp.3, 2012, https://doi.org/10.1515/hmbci-2016-0025
  29. Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity vol.28, pp.3, 2012, https://doi.org/10.1515/hmbci-2016-0025
  30. Osteoporosis, obesity, and sarcopenia on abdominal CT: a review of epidemiology, diagnostic criteria, and management strategies for the reporting radiologist vol.42, pp.9, 2017, https://doi.org/10.1007/s00261-017-1124-5
  31. Serum 25-hydroxyvitamin D and bone turnover markers in Palestinian postmenopausal osteoporosis and normal women vol.12, pp.1, 2012, https://doi.org/10.1007/s11657-017-0306-7
  32. Osteoporosis: Treat-to-Target vol.15, pp.2, 2012, https://doi.org/10.1007/s11914-017-0350-7
  33. Osteoporosis: a discussion on the past 5 years vol.10, pp.2, 2012, https://doi.org/10.1007/s12178-017-9410-y
  34. Bone mineral density in people living with HIV: a narrative review of the literature vol.14, pp.None, 2012, https://doi.org/10.1186/s12981-017-0162-y
  35. Circulating microRNAs Correlated with Bone Loss Induced by 45 Days of Bed Rest vol.8, pp.None, 2012, https://doi.org/10.3389/fphys.2017.00069
  36. Significance of the ionized calcium measurement to assess calcium status in osteopenic/osteoporosis postmenopausal outpatients vol.33, pp.5, 2017, https://doi.org/10.1080/09513590.2016.1270932
  37. Menopause transition promotes distinct modulation of mRNAs and miRNAs expression in calvaria and bone marrow osteoblastic cells : Menopause transition modulates gene expression vol.42, pp.1, 2018, https://doi.org/10.1002/cbin.10802
  38. A role for bone turnover markers β-CrossLaps (CTX) and amino-terminal propeptide of type I collagen (PINP) as potential indicators for disease progression from MGUS to multiple myeloma vol.59, pp.10, 2012, https://doi.org/10.1080/10428194.2017.1421757
  39. Role of vitamin D in energy and bone metabolism in postmenopausal women with type 2 diabetes mellitus: A 6‐month follow‐up evaluation vol.9, pp.1, 2012, https://doi.org/10.1111/jdi.12666
  40. Associations Between Serum Bone Biomarkers in Early Breast Cancer and Development of Bone Metastasis: Results From the AZURE (BIG01/04) Trial vol.110, pp.8, 2012, https://doi.org/10.1093/jnci/djx280
  41. Combining information from multiple bone turnover markers as diagnostic indices for osteoporosis using support vector machines vol.24, pp.2, 2012, https://doi.org/10.1080/1354750x.2018.1539767
  42. Relationships of social support, health‐promoting lifestyles, glycemic control, and bone turnover among adults with type 2 diabetes vol.17, pp.1, 2012, https://doi.org/10.1111/jjns.12280
  43. Effect of Collagen Peptide, Alone and in Combination with Calcium Citrate, on Bone Loss in Tail-Suspended Rats vol.25, pp.4, 2012, https://doi.org/10.3390/molecules25040782
  44. Six Sigma Analysis of Vitamin D Measurement Using External Quality Assessment Program vol.52, pp.2, 2012, https://doi.org/10.15324/kjcls.2020.52.2.91
  45. Status of circulating bone turnover markers in elderly osteoporosis/osteopenia patients in comparison with healthy subjects vol.14, pp.3, 2012, https://doi.org/10.1515/abm-2020-0015
  46. Variation of urinary and serum bone turnover marker reference values among pre and postmenopausal women in Asia: a systematic review vol.15, pp.1, 2012, https://doi.org/10.1007/s11657-020-00722-7
  47. Effects of post exercise protein supplementation on markers of bone turnover in adolescent swimmers vol.17, pp.1, 2012, https://doi.org/10.1186/s12970-020-00350-z
  48. Exploring the Relationship of Bone Turnover Markers and Bone Mineral Density in Community-Dwelling Postmenopausal Women vol.2021, pp.None, 2012, https://doi.org/10.1155/2021/6690095
  49. Bone Phenotyping Approaches in Human, Mice and Zebrafish – Expert Overview of the EU Cost Action GEMSTONE (“GEnomics of MusculoSkeletal traits TranslatiOnal NEtwork”) vol.12, pp.None, 2021, https://doi.org/10.3389/fendo.2021.720728