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Disruption of bone homeostasis, driven by increased osteoclastic resorption and suppressed osteoblastic formation, leads to osteolytic lesions and skeletal\u2010related events, contributing substantially to morbidity and mortality. Bone turnover markers (BTMs) provide a non\u2010invasive means of assessing bone metabolism, with potential applications in disease monitoring, prognostication, risk stratification from monoclonal gammopathy of undetermined significance (MGUS) to MM and evaluation of response to myeloma and osteoporosis therapies. This review examines the clinical relevance of BTMs in plasma cell dyscrasias, including MM, MGUS and smouldering MM. Bone formation markers, such as bone\u2010specific alkaline phosphatase and procollagen type I N\u2010terminal propeptide, reflect osteoblastic activity, while resorption markers, including carboxy\u2010terminal collagen crosslinks and deoxypyridinoline, indicate osteoclastic activity. Although several BTMs correlate with disease burden and progression, their routine clinical use is limited by biological variability, renal impairment and lack of assay standardisation. As myeloma therapies continue to evolve, further research is needed to define the role of BTMs alongside imaging and clinical risk models to optimise bone disease management.<\/jats:p>","DOI":"10.1111\/bjh.70467","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T08:45:17Z","timestamp":1775637917000},"page":"1909-1923","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Biochemical bone biomarkers in plasma cell dyscrasias"],"prefix":"10.1111","volume":"208","author":[{"given":"Guido","family":"Nador","sequence":"first","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Vijjhalwar","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad 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