Oral Bisphosphonates (BPs) are the mainstay of osteoporotic treatment, however long-term adherence remains a challenge, primarily owing to the chronic character of the disease and the regimen complexity. Poor compliance has been shown to have a clear link to fracture risk. The role of bone turnover markers (BTMs) as a tool to ascertain adherence and response to therapy is supported by their rapid response to treatment; a decrease in values is witnessed within days or weeks of commencing treatment. A greater reduction of serum CTX and NTX is evidenced with alendronate and ibandronate compared to risedronate. A change in bone formation BTMs appears to be related to vertebral fracture risk reduction, whereas no significant relationship is evident for hip and non-vertebral fractures. The utility of BTMs as an adjunct for monitoring withdrawal of treatment with oral BP has also been suggested. Finally, studies evaluating BTMs as an intervention, failed to demonstrate any effect on adherence. This review explores the challenge of long-term adherence with bisphosphonates and provides an analytic framework with respect to the role of BTMs in monitoring bisphosphonate treatment, adherence and the offset of treatment effect.

中文翻译：

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长期坚持的挑战：骨转换标志物在监测双膦酸盐治疗骨质疏松症中的作用

口服双膦酸盐 (BPs) 是骨质疏松症治疗的中流砥柱，但长期坚持仍然是一个挑战，主要是由于该疾病的慢性特征和治疗方案的复杂性。依从性差已被证明与骨折风险有明显的联系。骨转换标志物 (BTM) 作为确定治疗依从性和反应的工具的作用得到了它们对治疗的快速反应的支持；开始治疗后数天或数周内会出现数值下降。与利塞膦酸盐相比，阿仑膦酸盐和伊班膦酸盐证明了血清 CTX 和 NTX 的更大降低。骨形成 BTM 的变化似乎与椎骨骨折风险降低有关，而髋部和非椎骨骨折则没有明显的相关性。也有人建议使用 BTMs 作为监测口服血压治疗戒断的辅助手段。最后，将 BTM 评估为干预措施的研究未能证明对依从性有任何影响。本综述探讨了长期坚持使用双膦酸盐的挑战，并就 BTM 在监测双膦酸盐治疗、依从性和治疗效果抵消方面的作用提供了一个分析框架。