Selected Markers Of Bone Turnover
	Bone Formation	Bone Resorption
Plasma	Bone Specific ALP P1NP ALP Osteocalcin	CTX
Urine		PYR and DPD

Changes in biochemical markers of bone turnover in metabolic bone disease
Use	Bone Formation	Bone Resorption
Osteoporosis	Increased or normal	Increased or normal
Osteoporosis, monitoring antiresorptive therapy	Decrease by 30% from baseline to be effective	Decrease by >50% from baseline to be effective
Corticosteroids on bone	Osteocalcin decrease	Small effect on resorption markers depending on duration of treatment
Myeloma	May be low, normal or increased, depending on therapy and recent fractures	Greatly increased
Chronic Renal Failure	Normal or increased (especially osteocalcin, due to decreased renal excretion)	Normal or increased
Paget’s disease	Increased (especially ALP and BSALP)	Increased, according to activity of disease
Fracture (Depends on location of fracture)	Increased for up to a year	Increased for up to 6 months
Osteomalacia	Often increased	Often increased
Primary hyperparathyroidism	Often increased	Often increased