Bone markers for osteoporosis

Bone markers measure your bone turnover – the process where old bone tissue is broken down, and new bone tissue is built in its place. Bone marker tests are most commonly used to assess how well your medication is working.

Most osteoporosis medications work by decreasing the rate that old bone tissue is broken down. Bone marker tests show how fast this is happening.

Your doctor uses the results of this test to make decisions about your medication.

The test is only available in specialist centres where more information is needed to decide which medication you need. Not everyone needs a bone marker test. Your doctor can advise you whether you need a specialist referral.

How it works

During bone turnover, the specialist cells that break down old bone (osteoclasts), and lay down new bone (osteoblasts), leave chemical traces behind. These chemical traces are called 'bone markers'.

The test measures the levels of the different bone markers in your blood or urine, to work out how active your osteoclasts and osteoblasts are.

What to expect

If you're referred for a bone marker test, you need to supply a blood and/or urine sample, which your doctor sends to a laboratory for testing.

Blood test

A blood sample needs to be taken from you by your doctor, or nurse. This is done through a standard blood test.

Sometimes you're asked to make your appointment for your blood test first thing in the morning. This is when bone turnover is at its highest.

Urine test

If you’re asked to provide a urine sample, you need to capture a sample the second time you pass urine in a morning, and as early as possible. This is when bone turnover is at it's highest.

If you’re asked to provide a follow-up sample, it should be taken at the same time of day.

Understanding your results

The results for this test are complex, and are analysed by an osteoporosis specialist.

After your test

Your doctor uses the results of the bone marker test, sometimes in conjunction with other tests, to make sure you’re on the best treatment for you.

If the test shows your medication is working well, you may be advised to continue taking it and invited back for further tests in the future.

If the test shows your medication isn't slowing down bone turnover as well as it could be, your doctor may reassess your treatment plan.

Content reviewed: December 2018

(Updated December 2021)