Table 22.

Predicting Response of Bone Lesions to Bisphosphonate Treatment

Risk‐benefit balance

Biochemical markers of bone turnover can be easily assessed by analysis of blood or urine samples, and several markers of bone turnover are associated with scintigraphic extent of bone lesions after bisphosphonate therapy.

Quality of evidence

Very low

Patient values and preferences

Patients may value undergoing biochemical tests to predict the extent of PDB and response of bone lesions to bisphosphonates.

Costs and use of resources

The strongest predictor was PINP, but the confidence intervals overlapped with sβCTX, uNTX, and sNTX. These markers performed better than total ALP but are more expensive and not widely available.

Recommendation

Measurement of PINP is recommended to predict lesion extent, as defined by scintigraphy, after bisphosphonate therapy.