Recently the clinical application of bone turnover markers (BTMs) have been achieved significant progress and the measurements of these indices give us better understanding of pathogenesis of osteoporosis. BTMs are known the bone formation marker, the bone resorption marker and the bone matrix-related marker, respectively. In the Guidelines for the Use of Bone Metabolic Markers in the Diagnosis and Treatment of Osteoporosis (2012 Edition) from publishing Japan Osteoporosis Society Committee, the newly and commonly BTMs were considered to give the normal reference value in Japanese people, the influence of renal function on BTMs. The flow chart of the measurement of bone resorption markers and bone formation markers when selecting drug treatment for osteoporosis, the evaluation of therapeutic effects of bone antiresorption drugs and/or bone formation promoting drug using bone resorption markers and/or bone formation marker were corrected newly in the guideline 2012 edition. Moreover, BTMs were suggested to contribute to adhere with osteoporosis treatment. BTMs are adapted to selection of the drug for osteoporosis and to evaluate the drug efficacy. Therefore, it is very important to guide the proper application and assessment of BTMs in clinical practice.