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Biomarker GSTP1 Full name Glutathione S-transferase P1 Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions Oxidative stress and bone metabolism
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Idiopathic Osteoporosis (Adolescent/Young Adult Type)
Organ Bone Test Sample / Technology Platform Bone tissue (immunohistochemistry, Western blot)
Pathobiological Mechanisms Participates in antioxidant stress, with reduced GSTP1 expression in the bone tissue of idiopathic patients, leading to increased ferroptosis of osteocytes and decreased bone strength.
Clinical Availability Status Research phase
Notes and Dynamics Positively correlated with iron accumulation in bone tissue, which may explain the mechanism of iron overload in idiopathic osteoporosis; its inhibitor can alleviate bone loss in mouse models.
Biomarker peripheral blood exosomes circRNA_0007059 Full name Molecular Type Circular RNA
Molecular Formula Molecular Weight Core Functional Dimensions Regulation of osteocyte differentiation
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Idiopathic Osteoporosis (Adolescent/Young Adult Type)
Organ Bone Test Sample / Technology Platform peripheral blood exosomes(qRT-PCR、RNA-seq)
Pathobiological Mechanisms As a ceRNA, it binds to miR-378, upregulates BMP-2 expression, and promotes osteogenic differentiation; its level is significantly reduced in exosomes of idiopathic patients.
Clinical Availability Status Research phase
Notes and Dynamics circRNA_0007059 shows promise as a non-invasive biomarker for juvenile osteoporosis
Biomarker LCN2 Full name Serum Lipid Carrier Protein 2 Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions Inflammation and bone metabolism
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Secondary osteoporosis (diabetes-related type)
Organ Bone, Immune system Test Sample / Technology Platform Serum (ELISA, Western blot)
Pathobiological Mechanisms Diabetes-associated chronic inflammation induces LCN2 upregulation, which promotes osteoclast differentiation by activating the NF-κB pathway
Clinical Availability Status Research phase
Notes and Dynamics Can serve as an inflammatory biomarker for diabetic osteoporosis
Biomarker IGF-1 Full name Serum insulin-like growth factor-1 Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions bone formation regulation
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Secondary osteoporosis (diabetes-related type)
Organ Bone Test Sample / Technology Platform Serum (Chemiluminescence, ELISA)
Pathobiological Mechanisms Insulin resistance in diabetic patients leads to reduced IGF-1 synthesis, which inhibits osteoblast proliferation and collagen synthesis, thereby exacerbating bone loss.
Clinical Availability Status Clinically available (for auxiliary evaluation)
Notes and Dynamics It is positively correlated with lumbar BMD in diabetic patients; IGF-1 <100 ng/mL indicates impaired bone formation function and increased fracture risk.
Biomarker sPD-L1 Full name Serum soluble PD-L1 Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions Immune Regulation and Bone Metabolism
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Secondary osteoporosis (glucocorticoid-induced)
Organ Bone, Immune system Test Sample / Technology Platform Serum (ELISA, flow cytometry)
Pathobiological Mechanisms Glucocorticoids induce immunosuppression, and elevated sPD-L1 suppresses T cell activity, indirectly promoting osteoclast activation
Clinical Availability Status Research phase
Notes and Dynamics It is positively correlated with the dosage of glucocorticoids; patients with sPD-L1>2 ng/mL exhibit a 25% reduced response rate to bisphosphonate therapy.
Biomarker FGF23 Full name Fibroblast Growth Factor 23 Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions phosphorus metabolism regulation
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Secondary osteoporosis (glucocorticoid-induced)
Organ Bone, Kidney Test Sample / Technology Platform Serum (ELISA, Immunoassay by Radioimmunoassay IRMA)
Pathobiological Mechanisms Glucocorticoids inhibit renal 1α-hydroxylase activity, leading to elevated FGF-23 levels, which promotes phosphorus excretion and results in impaired bone mineralization.
Clinical Availability Status Clinical trials in progress
Notes and Dynamics A level> 80 pg/mL indicates abnormal mineralization induced by glucocorticoids; combined with serum phosphorus testing, the diagnostic accuracy can be improved to 79%.
Biomarker PBMC Full name peripheral blood monouclear cells Molecular Type microRNA
Molecular Formula Molecular Weight Core Functional Dimensions Regulation of osteocyte differentiation
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary osteoporosis (senile)
Organ Bone Test Sample / Technology Platform Peripheral blood PBMC (qRT-PCR、RNA-seq)
Pathobiological Mechanisms Targeted inhibition of osteoblast transcription factor ATF4 and high expression of miR-133a in peripheral blood mononuclear cells (PBMCs) of elderly patients suppress osteogenic differentiation, exacerbating bone loss
Clinical Availability Status Research phase
Notes and Dynamics negatively correlated with lumbar BMD; it can serve as a potential molecular biomarker for the early diagnosis of senile osteoporosis
Biomarker S1P Full name Plasma sphingosine-1-phosphate Molecular Type lipid
Molecular Formula Molecular Weight Core Functional Dimensions Regulation of osteocyte migration
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary osteoporosis (senile)
Organ Bone, Bone marrow Test Sample / Technology Platform Plasma (LC-MS/MS, High Performance Liquid Chromatography HPLC)
Pathobiological Mechanisms Regulation of osteoclast precursor migration via the S1PR1/S1PR2 pathway, elevated plasma S1P levels in elderly patients promote bone resorption, and imbalance of bone marrow-S1P gradient
Clinical Availability Status Research phase
Notes and Dynamics Elderly patients with S1P>3.5 μmol/L exhibit a 5.5-fold increased risk of hip fracture; the plasma/bone marrow ratio provides a more accurate assessment of bone resorption activity.
Biomarker DKK-1 Full name serum Dickkopf-1 Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions inhibition of bone formation
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary osteoporosis (senile)
Organ Bone Test Sample / Technology Platform Serum (ELISA, Western blot)
Pathobiological Mechanisms Inhibition of Wnt pathway activity: In elderly patients, the decline in osteocyte function leads to increased secretion of DKK-1, which further suppresses osteogenesis.
Clinical Availability Status Research phase
Notes and Dynamics It is negatively correlated with lumbar BMD in elderly males (r=-0.42); teriparatide treatment can reduce its levels and reverse the state of bone formation inhibition.
Biomarker Cathepsin K Full name Serum cysteine protease K Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions bone resorption monitoring
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary osteoporosis (senile)
Organ Bone Test Sample / Technology Platform Serum (ELISA、LC-MS/MS)
Pathobiological Mechanisms Osteoclast-specific proteases degrade type I collagen and non-collagenous proteins in the bone matrix, with elevated levels in elderly patients due to excessive osteoclast activation.
Clinical Availability Status Clinical trials in progress
Notes and Dynamics Positively correlated with bone resorption rate, it can predict the risk of vertebral fractures in elderly patients; a ≥50% reduction in cathepsin K inhibitor (e.g., odanacatib) levels post-treatment indicates significant therapeutic efficacy.
Biomarker POSTN Full name Serum periostin Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions bone cortical metabolism
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary Osteoporosis (Postmenopausal)
Organ Bone (Cortical bone) Test Sample / Technology Platform Serum (ELISA, immunohistochemistry)
Pathobiological Mechanisms Primarily secreted by periosteal osteoblasts, it regulates collagen cross-linking and cortical bone strength. A decline in postmenopausal levels leads to increased cortical bone fragility.
Clinical Availability Status Scientific research verification
Notes and Dynamics It is independently associated with the risk of non-vertebral fractures (HR=1.89), particularly suitable for evaluating areas predominantly composed of cortical bone (e.g., hip); it holds promise as a periperal metabolic marker.
Biomarker Sclerostin Full name seric scleroprotein Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions inhibition of bone formation
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary Osteoporosis (Postmenopausal)
Organ Bone Test Sample / Technology Platform Serum (ELISA, electrochemiluminescence assay)
Pathobiological Mechanisms Secreted by osteocytes, it inhibits osteoblast differentiation by blocking the Wnt/β-catenin pathway, and elevated levels after menopause exacerbate bone formation inhibition.
Clinical Availability Status Clinical trials in progress
Notes and Dynamics negatively correlated with lumbar BMD (r=-0.38); the degree of reduction in levels after treatment with sclerosing protein antibody (Romosozumab) was positively correlated with BMD increase
Biomarker OPG Full name serum osteoprotegerin Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions bone metabolism regulation
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary Osteoporosis (Postmenopausal)
Organ Bone Test Sample / Technology Platform Serum (ELISA, Western blot)
Pathobiological Mechanisms As a decoy receptor for RANKL, it inhibits osteoclast differentiation and activity. The decline in estrogen levels after menopause leads to reduced OPG expression, resulting in an imbalance in bone resorption.
Clinical Availability Status Clinical trials in progress
Notes and Dynamics The diagnostic value of individual detection is limited, whereas combined detection with RANKL (OPG/RANKL ratio) improves the accuracy of postmenopausal osteoporosis risk stratification, with a ratio <0.8 indicating high risk.
Biomarker β-CTX Full name Serum β-collagen cross-linked C-terminal peptide Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions Bone Resorption Assessment
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary Osteoporosis (Postmenopausal)
Organ Bone Test Sample / Technology Platform Serum (Chemiluminescence, ELISA)
Pathobiological Mechanisms Type I collagen degradation products during bone resorption specifically reflect osteoclast-mediated bone matrix destruction, with significantly elevated levels in postmenopausal estrogen deficiency.
Clinical Availability Status Widely available
Notes and Dynamics Significantly influenced by diet, blood sampling requires fasting; positively correlated with hip fracture risk, with a 2.3-fold increase in fracture risk when levels exceed 0.5 ng/mL.
Biomarker PINP Full name Serum type I procollagen N-terminal prepeptide Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions Bone formation monitoring
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary Osteoporosis (Postmenopausal)
Organ Bone Test Sample / Technology Platform Serum (fully automated chemiluminescence immunoassay analyzer, ELISA)
Pathobiological Mechanisms The precursor fragments released by osteoblasts during type I collagen synthesis directly reflect the collagen synthesis rate and serve as a sensitive indicator of bone formation.
Clinical Availability Status Widely available
Notes and Dynamics Bone formation reference markers recommended by IOF/IFCC; an increase of ≥20% within 3 months post-treatment indicates the onset of anabolic drug (e.g., teriparatide) and is significantly associated with increased spinal BMD.
Biomarker BALP Full name Serum bone-specific alkaline phosphatase Molecular Type protein
Molecular Formula Molecular Weight Core Functional Dimensions Bone formation assessment
Disease(or Constitution) Osteoporosis (OP) Disease Subtypes Primary Osteoporosis (Postmenopausal)
Organ Bone Test Sample / Technology Platform Serum (Enzyme-Linked Immunosorbent Assay (ELISA), Chemiluminescence Assay)
Pathobiological Mechanisms Secreted by osteoblasts, it catalyzes bone matrix mineralization. Elevated levels reflect enhanced osteoblast activity and may early indicate abnormal bone formation.
Clinical Availability Status Widely available
Notes and Dynamics It was negatively correlated with lumbar BMD, and combined with PINP, the diagnostic sensitivity of postmenopausal osteoporosis was improved to 82%; A decline of ≥40% indicates efficacy of anti-osteoporosis therapy

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This study was supported by the Scientific Research Innovation Capability Support Project for Young Faculty (SRICSPYF-ZY2025112), the Fundamental and Interdisciplinary Disciplines Breakthrough Plan of the Ministry of Education of China (JYB2025XDXM612)

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