Emerging evidence highlights the utility of bone turnover markers such as tartrate-resistant acid phosphatase 5b (TRACP-5b), procollagen type 1 N-terminal propeptide (P1NP), and bone-specific alkaline phosphatase (BAP) in predicting the early anabolic response to Romosozumab, particularly in patients with severe osteoporosis or high baseline turnover rates [31]. This evidence concerns the gene ACP5 and osteoporosis.