Abstract

The balance between bone resorption and bone formation is maintained through a complex regulatory system of systemic and local factors acting on bone cells, such as calcium regulating and sex hormones, growth factors and cytokins. Furthermore, the competence of the bone cells and the number of active cells will determine the production of bone matrix proteins, while other incompletely understood intrinsic mechanisms will determine mineralization and micro-structure. Exposure of the matrix after osteoclastic activation allows for proteolytic enzymes to commence the degradation of the collagenous structure. The signals responsible for termination of bone resorption and initiation of bone formation (coupling) are not yet completely understood. Nevertheless, a tight coupling between resorption and formation is required to maintain bone mass and to preserve the micro-architectural integrity of bone.

Based on this knowledge markers of bone metabolism have been developed. These markers have been evaluated in terms of their ability to predict fracture, change in bone mass, and response to pharmacological treatments in clinical trials and additionally to monitor treatment in clinic.

The lecture will cover the use of markers in clinical trial, interpretation of change in markers from currently available and potential new drugs and to what extent and how to best apply in clinic.