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Regular exercise can for the treatment of these metabolic disorders. Several limitations of our study should be considered. Firstly, we recognize the limitations of the classification model: it is based on BTM values proposed as treatment targets, the cutoffs are arbitrarily chosen, the two markers analysed reflect mainly the function of osteoblasts and osteoclasts, but biochemical indicators of the osteocyte activity, important factors in the maintenance of skeletal integrity, are not included currently these markers are used for research purposes. Although the proposed classification brings a conceptual shift in our understanding of the pathophysiology and clinical applications of bone turnover status, additional biochemical indicators of the complex multilayered regulatory mechanisms need to be found and considered in future classification. Thirdly, the study has been done in a single centre, and the patients were mainly Caucasian; that could affect the generalizability of the results. Fourthly, the cross-sectional design of the study does not allow causal conclusions, and, despite multivariate analyses with extensive adjustment for potential confounders, the possibility of residual unmeasured confounders could not be excluded.

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