Bone Turnover Markers in Pediatric Populations
Summary
Bone turnover markers reflect the rates of bone formation and resorption and are instrumental in assessing skeletal health in growing populations. In paediatric cohorts, rapid skeletal modelling and remodelling underpin accrual of peak bone mass, influencing lifelong fracture risk. Serum and urinary markers offer non-invasive insight into osteoblastic and osteoclastic activity, complementing imaging by dual-energy X-ray absorptiometry. Normative reference intervals must account for age, sex and pubertal stage, as marker levels rise in early adolescence and vary between boys and girls. Clinically, bone turnover markers facilitate early detection of metabolic bone diseases, guide nutritional and pharmacological interventions, and monitor response to therapies such as growth hormone or bisphosphonates. Global studies reveal regional differences linked to genetics, diet and vitamin D status, underscoring the need for population-specific standards. Combining serial measurements of multiple markers with anthropometry and biochemical indices enables a comprehensive assessment of bone health and growth trajectories in children and adolescents.
Research from Nature Portfolio
A seminal analysis established age- and sex-specific reference ranges for key bone formation and resorption markers in adolescents. The study measured procollagen type 1 N-propeptide and bone-specific alkaline phosphatase alongside β-CrossLaps, revealing that formation markers exceed adult kit references and vary significantly with pubertal progression. Age, sex and body mass index emerged as independent determinants of marker levels, while widespread vitamin D insufficiency appeared not to influence turnover marker variability. This work highlights the necessity of tailored paediatric reference intervals for accurate assessment of bone metabolism during rapid skeletal maturation.
Bone Turnover Markers in Pediatric Populations publication trend
The graph below shows the total number of articles in bone turnover markers in pediatric populations across all publications each year (not limited to Nature Index journals).
Technical terms
Bone turnover markers (BTMs): Biochemical molecules released during bone formation or resorption, used to assess skeletal metabolism.
Osteocalcin: A non-collagenous protein secreted by osteoblasts, indicative of bone formation, measurable in serum and urine.
Procollagen type 1 N-propeptide (P1NP): A peptide cleaved during collagen synthesis, serving as a sensitive marker of new bone formation.
C-terminal telopeptide of type I collagen (CTX): A degradation fragment released by osteoclasts during collagen breakdown, reflecting bone resorption.
Bone-specific alkaline phosphatase (BAP): An isoenzyme of alkaline phosphatase produced by osteoblasts, marking osteoblastic activity and mineralisation.
References
- Reference and Influential Factors of Serum Bone Markers in Chinese Adolescents. Scientific Reports (2017).
- Serum and Urinary Osteocalcin in Healthy 7- to 19-Year-Old Finnish Children and Adolescents. Frontiers in Pediatrics (2021).
- The Effect of BMI, Age, Gender, and Pubertal Stage on Bone Turnover Markers in Chinese Children and Adolescents. Frontiers in Endocrinology (2022).
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