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Abstract |
Biochemical Markers of Bone Metabolism - Update 1999 Part I: Basic Principles |
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Due to profound changes in the age structure of western industrialized countries, disorders of connective tissue, bone and mineral metabolism are becoming increasingly relevant in every day clinical practice. Consequently, the interest in, and the need for effective measures to be used in the screening, diagnosis and follow-up of such pathologies has markedly grown. Together with clinical and imaging techniques, indices of bone turnover play an important role in the assessmenf and differential diagnosis of metabolic bone disease such as primary hyperparathyroidism, osteomalacia, or Paget's disease of bone. In osteoporosis, more recent research has shown that bone markers may also be used to predict future bone loss and hip fractures (in larger cohorts of older patients), to identify individuals at risk for osteoporosis, to select therapy and to predict and monitor the therapeutic response in individual patients. In recent years, the development of new markers of bone metabolism has enriched the spectrum of serum and urine analytes used in the assessment of skeletal pathologies. Besides total alkaline phosphatase (TAP), which is routinely available from any laboratory, a host of other markers such as bone-specific alkaline phosphatase (BAP), osteocalcin (OC) or the collagen propeptides are being used to assess bone formation rates. All these additional parameters exhibit a significantly higher degree of tissue specificity than TAP. Bone resorption, formerly detected only by the measurement of urinary calcium and hydroxyproline, may now be measured more precisely by a number of new serum and urine markers. Among these, the pyridinium crosslinks and the higher molecular weight telopeptides of collagen type I are presently considered the most specific markers of bone resorption. More recently, bone sialoprotein (BSP) has been suggested as a resorption marker in serum. Tartrate-resistant acid phosphatase, of which band 5a is a specific product of active osteoclasts, is now measurable by immunoassay. The present article updates a review published five years ago in this journal. Part I surveys the biochemistry and other basic aspects of the currently available markers of bone metabolism. Part II reviews the clinical application of these markers in various clinical situations. |
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