High bone turnover

“Bone tissue with high turnover” refers to a physiological or pathological state of the skeleton characterized by an accelerated rate of bone remodeling, where the coupled processes of osteoclastic resorption and osteoblastic formation occur more rapidly than usual; it is not a discrete molecule or receptor and therefore is not a conventional therapeutic target. High turnover can occur during life stages such as puberty and in diseases including osteoporosis, Paget’s disease, primary hyperparathyroidism, and CKD–mineral bone disorder; it is assessed using bone turnover markers such as PINP, bone ALP, osteocalcin (formation) and CTX, NTX, TRACP-5b (resorption), often alongside iPTH in relevant conditions. Therapeutic interventions that “target” high turnover act on bone cells or signaling pathways—e.g., bisphosphonates inhibit osteoclasts, RANKL inhibitors block osteoclastogenesis, SERMs/estrogen decrease resorption, and calcitonin reduces osteoclast activity—thereby lowering excessive remodeling rates and fracture risk.

Other names

High bone turnoverIncreased bone remodelingAccelerated bone turnoverHigh bone resorption and formation state

Inhibition of osteoclast-mediated bone resorption (bisphosphonates); Neutralization of RANKL to block osteoclast formation and activity (RANKL inhibitors); Modulation of estrogen signaling to reduce bone resorption and improve balance of remodeling (SERMs, estrogen therapy); Direct antiresorptive effect decreasing osteoclast activity (calcitonin)