Is monitoring osteoporosis therapy worthwhile

TL;DR: There is no scientific justification for the use of either BMD or bone turnover markers in the routine monitoring of therapy, but patients should be given adequate information about their treatment and routine follow-up should be provided to enable discussion of treatment-related issues.

Abstract: Bone mineral density (BMD) measurements are widely recommended for the routine monitoring of osteoporosis treatment. However, the evidence base to support this approach is weak, since treatmentinduced changes in BMD take up to three years to detect and in any case do not predict the associated reduction in fracture risk. Biochemical markers have potential for monitoring since they change rapidly in response to treatment and are more predictive of fracture reduction, but issues related to the variability of their measurement greatly reduce their utility in clinical practice. Neither BMD nor bone turnover markers have been shown to improve adherence to therapy. In contrast, there is evidence that discussion with a healthcare professional improves treatment adherence, regardless of feedback about monitoring tests. At present, there is no scientific justification for the use of either BMD or bone turnover markers in the routine monitoring of therapy, but patients should be given adequate information about their treatment and routine follow-up should be provided to enable discussion of treatment-related issues. IBMS BoneKEy. 2009 March;6(3):99-106. ©2009 International Bone & Mineral Society