Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club

OBJECTIVES: To review the clinical value of bone turnover markers (BTM), to initiate and/or monitor anti-resorptive treatment for osteoporosis compared with bone mineral density (BMD) and to evaluate suitable BTM and changes in BTM levels for significance of treatment efficiency. METHODOLOGY: Consensus meeting generating guidelines for clinical practice after review and discussion of the randomised controlled trials or meta-analyses on the management of osteoporosis in postmenopausal women. RESULTS: Although the correlation between BMD and BTM is statistically significant, BTM cannot be used as predictive markers of BMD in an individual patient. Both are independent predictors of fracture risk, but BTM can only be used as an additional risk factor in the decision to treat. Current data do not support the use of BTM to select the optimal treatment. However, they can be used to monitor treatment efficiency before BMD changes can be evaluated. Early changes in BTM can be used to measure the clinical efficacy of an anti-resorptive treatment and to reinforce patient compliance. DISCUSSION: Determining a threshold of BTM reflecting an optimal long-term effect is not obvious. The objective should be the return to the premenopausal range and/or a decrease at least equal to the least significant change (30%). Preanalytical and analytical variability of BTM is an important limitation to their use. Serum C-terminal cross-linked telopeptide of type I collagen (CTX), procollagen 1 N terminal extension peptide and bone specific alkaline phosphatase (BSALP) appear to be the most suitable. Conclusion: Consensus regarding the use of BTM resulted in guidelines for clinical practice. BMD determines the indication to treat osteoporosis. BTM reflect treatment efficiency and can be used to motivate patients to persist with their medication.Consensus Development ConferenceJournal ArticlePractice GuidelineResearch Support, Non-U.S. Gov'tReviewSCOPUS: cp.jFLWOAinfo:eu-repo/semantics/publishe

"European identity(ies) in matters of institutional law: 1st and 3rd pillars: Proper community identity versus classic intergovernmental identity of the European Union"

Is there a European identity? This is the question addressed in this panel dedicated to "European Identity." So, as I’m asked if there is a European identity, I will try to answer the question, "Is there a European identity in matters of institutional law?" But what does this question mean exactly? First of all, let’s remember that European law is part of international law. Let’s also remember that the European Community is an international organization just like NATO, the Council of Europe, and so on. If we want to see if there is a European identity in matters of institutional law, we will have to compare the European Union with other international organizations, and compare its institutional law with general international law. In other words, we will try to see if there are some specificities in European law in comparison to general international law. And we will try to detect if there are particularities in the European Union in comparison to other international organizations. Therefore, let’s have a look at five aspects of European institutional law: 1) the community legal order; 2) the community institutions; 3) the decision-making process; 4) the relations with the member States; 5) the relations with the sub-national level. After looking at the facts, we will try to draw some conclusions