REVISTA MEDICALÅ ROMÂNÅ – VOLUMUL LXIII, NR. 3, An 2016 211 PROBLEME DE CERCETARE REFERATE GENERALE EMERGING APPOACH OF BONE REMODELLING INDICES Mara Carsote 1 , Adina Ghemigian 1 , Razvan Petrescu 2 , Otilia Radu 3 , Rene Baloescu 4 , Ana Valea 5 1 “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest 2 Medlife, Brasov 3 “Carol Davila” University of Medicine and Pharmacy, Bucharest 4 “C.I. Parhon” National Institute of Endocrinology, Bucharest 5 “Iuliu Hatieganu” University of Medicine and Pharmacy & Clinical County Hospital, Cluj-Napoca Corresponding author: Mara Carsote MD, PhD; “C.I. Parhon” National Institute of Endocrinology, 34-38 Aviatorilor Avenue, District 1, Bucharest, Romania E-mail: carsote_m@hotmail.com ABSTRACT The field of osteoporosis, especially of primary type, tidily connected with estrogen deprivation and aging, is complex and dynamic. Bone turnover markers (BTM) have been and still are a hot spot on this panorama, because no straight cut lines are found yet. We aim to briefly introduce the current status of BTM, as a short commentary. BTM have a high inter- and intra- individual variation, they are rather expensive for daily prac- tice, they are not necessary to diagnose osteoporosis. Low or normal levels do not necessary mean that a person will not suffer fragility fracture while a higher level is associated with an increased fracture risk. More- over, BTM seem better players for clinical studies to point out the efficacy of anti-osteoporotic drugs rather than helping each patient’s decision. BTM prematurely detect remodelling variations before DXA. No algo- rithm or calculation model of fracture prediction has incorporated yet BTM, most probably due to heterogene- ity of reports. Traditional BTM are alkaline phosphates, osteocalcin, and collagen- derived fragments. New BTM, that proved useful, are represented by P1NP. Atypical BTM like osteoprotegerin, sclerostin, and sero- tonin are still far from daily practitioners’ assessment. Regardless classical or modern, the way that BTM represent a reflection of skeleton health is still an emerging subject. Keywords: bone turnover marker, serotonin, osteoporosis INTRODUCTION The field of osteoporosis, especially of primary type tidily connected with estrogen deprivation and aging, is complex and dynamic. Bone turnover markers (BTM) have been and still are a hot spot on this panorama because no straight cut lines are found yet. (1,2,3) OBJECTIVE We aim to briefly introduce the current status of BTM, a domain where questions are still unan- swered. MATERIAL AND METHOD This is a short commentary regarding a modern theme in menopausal osteoporosis field using PubMed. GENERAL CONTEXT Some facts about BTM are widely recognised like: a high inter- and intra- individual variation is found, they are rather expensive for daily practice, they are not strictly necessary to obtain the diagno- sis of osteoporosis while a lower or normal levels do not necessary mean that a person will not suffer an osteoporotic fracture but a higher level is associ- ated with an increased fragility fracture risk. (4-6) Moreover, BTM seem better players for clinical studies to point out the usefulness of anti-osteopo- rotic drugs rather than helping each patient’s deci- sion. (7) Meta-analysis on menopausal females showed mild negative correlation between BTM and BMD (Bone Mineral Density) at DXA (Dual- Energy X-Ray Absorptiometry); the most useful results are for alkaline phosphatase, osteocalcin, CTX (blood C-terminal cross-linking telopeptides of type I collagen), NTX (urinary N-terminal cross-