Emerging Markers in Osteoporosis, A Review

Abstract

Osteoporosis is a global health concern with bone frailty and high fracture risk. Existing diagnostic paradigms largely rely on bone scanning and bone mineral density evaluation which are hindered by the delayed prediction of fractures, especially in high-risk groups. This review assesses existing and novel Osteoporosis biomarkers, their mechanisms, clinical efficacy, drawbacks, and discusses the best biomarkers in Osteoporosis risk stratification and management, to convert them into better patient care. An online search was conducted, including PubMed, Web of Science, Embase, and Google Scholar up to June 2026. Passed studies were reviewed critically and organized biomarkers into five different panels: traditional and bone turnover markers, mineral metabolism and endocrine regulators, inflammatory and immune mediators, novel metabolic and multi-omics biomarkers, and combined biomarker panels. The traditional markers are still useful in therapeutic monitoring, although they have a natural biological variability that cannot be used to achieve optimum diagnostic use. Combined and inflammatory mediator panels showed greater discriminative ability, with Net Reclassification Index improvements of 0.15-0.23, appropriately reclassifying 15-23 percent of intermediate-risk patients who were misidentified by traditional screening. The highest performance acquisition was experienced in diabetic cohorts, where density-based measurements often miss. The management of osteoporosis should be changed to precision medicine with multi-dimensional biochemical profiling. The clinical utility and cost-effectiveness of the integrated approach in biomarkers make them a mandatory complement to imaging and a crucial point in holistic patient care for improved prognosis.