{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T11:28:06Z","timestamp":1793618886987,"version":"4.5.0"},"reference-count":23,"publisher":"Walter de Gruyter GmbH","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2026-0941_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Bone status indices (BSIs) are increasingly used in metabolic bone disease, yet global laboratory practices remain poorly characterized. Building on recent IOF-IFCC nomenclature and ESCEO-IOF-IFCC recommendations, we conducted an international descriptive survey of BSI practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0941_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional web-based questionnaire was distributed to laboratory professionals through IFCC and IOF networks, email invitations, and professional networks. It covered assay availability, specimen type, analytical platforms, external quality assessment (EQA), reference intervals or clinical decision thresholds, reporting units, interpretation, and reimbursement. Data were analyzed descriptively after duplicate screening, consistency review, and unit standardization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0941_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We received 231 responses, including 225 with geographic information from 41 countries across six continents. Marked heterogeneity was observed in analytical platforms, specimen types, reporting units, reference intervals or decision thresholds, EQA participation, and reimbursement. Reference intervals varied considerably, even among laboratories using the same manufacturer and instrument. EQA participation was high for total alkaline phosphatase (ALP) and parathyroid hormone (PTH), but lower for \u03b2-isomerized C-terminal telopeptide of type I collagen (\u03b2-CTX-I) and procollagen type I N-propeptide (PINP). Adoption of \u03b2-CTX-I and PINP was incomplete, although higher among laboratories following osteoporosis patients. Access to bone-specific ALP and tartrate-resistant acid phosphatase 5b remained limited. PTH testing was poorly harmonized because second- and third-generation assays were used in parallel. Vitamin D decision thresholds varied widely, and misordering of 1,25(OH)\n                      <jats:sub>2<\/jats:sub>\n                      D instead of 25(OH)D was frequently perceived.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0941_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Global BSI laboratory practice remains highly heterogeneous. Harmonized units, intervals or decision thresholds, interpretative practices, EQA participation, assay access, and clinician education are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2026-0941","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:56:47Z","timestamp":1786024607000},"page":"2733-2756","source":"Crossref","is-referenced-by-count":0,"title":["IOF-IFCC international survey of global laboratory practices for bone status indices"],"prefix":"10.1515","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0947-2226","authenticated-orcid":false,"given":"Etienne","family":"Cavalier","sequence":"first","affiliation":[{"name":"Department of Clinical Chemistry , CHU de Li\u00e8ge and Centre de Recherche Int\u00e9gr\u00e9 Sur Les M\u00e9dicaments (CIRM), University of Li\u00e8ge , Li\u00e8ge , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6714-0812","authenticated-orcid":false,"given":"Georgia","family":"Kapoula","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department , General Hospital of Lamia , Lamia , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4909-0065","authenticated-orcid":false,"given":"Harjit P.","family":"Bhattoa","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Faculty of Medicine, University of Debrecen , Debrecen , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8365-985X","authenticated-orcid":false,"given":"Giovanni","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Biochemistry , IRCCS Ospedale Galeazzi-Sant\u2019Ambrogio , Milan , Italy"},{"name":"Department of Athletics , Strength and Conditioning, Pozna\u0144 University of Physical Education , Pozna\u0144 , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7896-9028","authenticated-orcid":false,"given":"Konstantinos","family":"Makris","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department , KAT General Hospital, Kifissia , Athens , Greece"},{"name":"Laboratory for Research of the\u00a0Musculoskeletal System \u201cTh. Garofalidis\u201d , Medical School, University\u00a0of\u00a0Athens , Athens , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9624-5210","authenticated-orcid":false,"given":"Niklas Rye","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry , Rigshospitalet , Copenhagen , Denmark"},{"name":"Translational Research Centre, Rigshospitalet , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2157-2564","authenticated-orcid":false,"given":"Michael S.","family":"Reid","sequence":"additional","affiliation":[{"name":"Alberta Precision Laboratories , Diagnostic and Scientific Research Centre , Calgary , Canada"},{"name":"Departments of Pathology and Laboratory Medicine, Cumming School of Medicine , Health Sciences Centre, University of Calgary , Calgary , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5847-0556","authenticated-orcid":false,"given":"Aylin Sepici","family":"Dincel","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Faculty of Medicine, Gazi University , Ankara , T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0633-8876","authenticated-orcid":false,"given":"Richard","family":"Pikner","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry and Bone Metabolism , Klatovska Hospital , Klatovy , Czech Republic"},{"name":"Department of Clinical Biochemistry and Haematology , Faculty of Medicine Pilsen, Charles University Prague , Pilsen , Czech Republic"},{"name":"Faculty of Health Care Studies , University of West Bohemia , Pilsen , Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0831-3031","authenticated-orcid":false,"given":"Samuel D.","family":"Vasikaran","sequence":"additional","affiliation":[{"name":"PathWest Laboratory Medicine WA , Murdoch , WA , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"2026110211032898958_j_cclm-2026-0941_ref_001","doi-asserted-by":"crossref","unstructured":"Burge, R, Dawson-Hughes, B, Solomon, DH, Wong, JB, King, A, Tosteson, A. 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