Real-world bone turnover marker use: impact on treatment decisions and fracture

N. E. Lane, K. Saag, T. J. O’Neill, M. Manion, R. Shah, U. Klause, R. Eastell

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Summary: The use of bone turnover marker (BTM) testing for patients with osteoporosis in the USA has not been well characterized. This retrospective US-based real-world data study found BTM testing has some association with treatment decision-making and lower fracture risk in patients with presumed osteoporosis, supporting its use in clinical practice. Introduction: The purpose of this study was to characterize bone turnover marker (BTM) testing patterns and estimate their clinical utility in treatment decision-making and fragility fracture risk in patients with osteoporosis using a retrospective claims database. Methods: Data from patients aged ≥ 50 years with newly diagnosed osteoporosis enrolled in the Truven MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Co-ordination of Benefits databases from January 2008 to June 2018 were included. Osteoporosis was ascertained by explicit claims, fragility fracture events associated with osteoporosis, or prescribed anti-resorptive or anabolic therapy. BTM-tested patients were 1:1 propensity score matched to those untested following diagnosis. Generalized estimating equation models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for testing versus no testing on both treatment decision-making and fragility fracture. Results: Of the 457,829 patients with osteoporosis, 6075 were identified with ≥ 1 BTM test following diagnosis; of these patients, 1345 had a unique treatment decision made ≤ 30 days from BTM testing. The percentage of patients receiving BTM tests increased significantly each year (average annual % change: + 8.1%; 95% CI: 5.6–9.0; p = 0.01). Patients tested were significantly more likely to have a treatment decision (OR: 1.14; 95% CI: 1.13–1.15), and testing was associated with lower odds of fracture versus those untested (OR: 0.87; 95% CI: 0.85–0.88). Conclusion: In this large, heterogeneous population of patients with presumed osteoporosis, BTM testing was associated with treatment decision-making, likely leading to fragility fracture reduction following use.

Original languageEnglish (US)
JournalOsteoporosis International
StateAccepted/In press - 2020
Externally publishedYes


  • Biochemical markers
  • Bone turnover
  • Fracture risk
  • Monitoring treatment
  • Osteoporosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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