Bone Turnover Markers and Glucocorticoid Treatments

  • Jean-Pierre DevogelaerEmail author
  • Anne DurnezEmail author
  • Damien GrusonEmail author
  • Daniel H. ManicourtEmail author
Reference work entry
Part of the Biomarkers in Disease: Methods, Discoveries and Applications book series (BDMDA)


Glucocorticoids (GCs) remain as the cornerstone of therapy in most inflammatory diseases, even if newly developed biological molecules became available. GCs are potent, possess a fast action, and are cheap and relatively easy to prescribe. However, their beneficial therapeutic activity has a nasty counterpart: quite a lot of complications, notably secondary osteoporosis, aseptic bone osteonecrosis, and fractures. The skeleton is continuously remodeling, old bone being resorbed and replaced by new young bone. GCs interfere with the bone turnover and provoke a disequilibrium in favor of bone loss and fragility. The mechanisms of bone fragility consist of a decreased activity and in apoptosis of osteoblasts, as well as an increase in bone resorption. These changes have already been observed histomorphometrically a long time ago in transiliac bone biopsies. Biological parameters of bone turnover, chiefly degradation products of type I collagen, can help to assess atraumatically the bone metabolism. If, in idiopathic osteoporosis, they can have a predictive value of bone loss, they cannot be considered as surrogates for bone mineral density measurements. In GC-OP, the concentrations of the bone turnover markers (BTMs) of bone formation dramatically and rapidly decrease, whereas the BTMs of bone resorption slightly increase. During GC therapy, they cannot be used as predictive tools of bone fragility on an individual basis. Other markers such as RANKL/RANK/osteoprotegerin seem to be promising in this aim, but this still awaits confirmation.


Glucocorticoid Bone turnover Biomarkers Osteoporosis Bone mineral density Bone remodeling Collagen Telopeptide 

List of Abbreviations




Beclomethasone dipropionate


Bone mineral density


Bone-specific alkaline phosphatase


Bone turnover markers




Crohn’s disease


Cartilage oligomeric matrix protein


Chronic obstructive pulmonary disease


Carboxy-terminal cross-linking telopeptide of type I collagen


Disease activity score




Femoral neck




Carboxy-terminal telopeptide of type I collagen




Juvenile idiopathic arthritis






Amino-terminal cross-linking telopeptide of type I collagen












Procollagen type I C-terminal propeptide


Procollagen type I N-terminal propeptide


Parathyroid hormone


Rheumatoid arthritis


Receptor activator of nuclear factor NF-kB


Receptor activator of nuclear factor NF-kB-ligand


Recombinant human






Systemic lupus erythematosus




Tartrate-resistant acid phosphatase


Ulcerative colitis


Urinary deoxypyridinoline


Urinary pyridinoline


Vertebral fracture


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© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Pôle de Pathologie RhumatismaleUniversite Catholique de LouvainBrusselsBelgium
  2. 2.Pôle de Recherche en Endocrinologie, Diabète et Nutrition et Département des Laboratoires Cliniques, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-LucUniversité catholique de LouvainBruxellesBelgium
  3. 3.AZ Jan PortaelsVilvoordeBelgium

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