The measurement of biochemical markers for bone metabolism is officially approved in clinical practice for osteoporosis in Japan for the purpose of assessment of bone metabolism and thus for rational selection of anti-osteoporotic drug and the early determination of its effect. In 2011 version of guideline for protection and treatment for osteoporosis and 2012 version of guideline for bone metabolic marker, the novel marker, such as P1NP, which responds precisely to newly-approved PTH (1-34) with bone-formation stimulating effect was focused. Furthermore, the effect of renal dysfunction on the markers which were secreted into urine was also emphasized because of the apparent increases in their serum levels independent of bone metabolic state.