Baseline bone turnover marker levels can predict change in bone mineral density during antiresorptive treatment in osteoporotic patients: the Copenhagen bone turnover marker study

S E Bønløkke, M S Rand, B Haddock, S Arup, C D Smith, J E B Jensen, P Schwarz, P Hovind, P S Oturai, L T Jensen, S Møller, P Eiken, K H Rubin, M F Hitz, B Abrahamsen, N R Jørgensen*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Summary: Anti-resorptive osteoporosis treatment might be more effective in patients with high bone turnover. In this registry study including clinical data, high pre-treatment bone turnover measured with biochemical markers was correlated with higher bone mineral density increases. Bone turnover markers may be useful tools to identify patients benefitting most from anti-resorptive treatment. Introduction: In randomized, controlled trials of bisphosphonates, high pre-treatment levels of bone turnover markers (BTM) were associated with a larger increase in bone mineral density (BMD). The purpose of this study was to examine this correlation in a real-world setting. Methods: In this registry-based cohort study of osteoporosis patients (n = 158) receiving antiresorptive therapy, the association between pre-treatment levels of plasma C-telopeptide of type I Collagen (CTX) and/or N-terminal propeptide of type I procollagen (PINP) and change in bone mineral density (BMD) at lumbar spine, total hip, and femoral neck upon treatment was examined. Patients were grouped according to their pre-treatment BTM levels, defined as values above and below the geometric mean for premenopausal women. Results: Pre-treatment CTX correlated with annual increase in total hip BMD, where patients with CTX above the geometric mean experienced a larger annual increase in BMD (p = 0.008) than patients with CTX below the geometric mean. The numerical pre-treatment level of CTX showed a similar correlation at all three skeletal sites (total hip (p = 0.03), femoral neck (p = 0.04), and lumbar spine (p = 0.0003)). A similar association was found for PINP where pre-treatment levels of PINP above the geometric mean correlated with a larger annual increase in BMD for total hip (p = 0.02) and lumbar spine (p = 0.006). Conclusion: Measurement of pre-treatment BTM levels predicts osteoporosis patients’ response to antiresorptive treatment. Patients with high pre-treatment levels of CTX and/or PINP benefit more from antiresorptive treatment with larger increases in BMD than patients with lower pre-treatment levels.

Original languageEnglish
JournalOsteoporosis International
Issue number10
Pages (from-to)2155-2164
Publication statusPublished - Oct 2022

Bibliographical note

© 2022. International Osteoporosis Foundation and National Osteoporosis Foundation.


  • Anti-resorptive treatment
  • Bisphosphonate
  • Bone turnover marker
  • CTX
  • Osteoporosis
  • PINP
  • Osteoporosis/drug therapy
  • Premenopause
  • Bone Density Conservation Agents/pharmacology
  • Humans
  • Procollagen/blood
  • Diphosphonates/pharmacology
  • Bone Density/drug effects
  • Biomarkers
  • Female
  • Registries
  • Peptide Fragments/blood
  • Collagen Type I/blood
  • Bone Remodeling/drug effects
  • Bone and Bones/drug effects
  • Cohort Studies


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