基于证据的骨转换生化标志物在骨质疏松症双膦酸盐治疗选择和监测中的应用指南：比利时骨俱乐部共识文件
Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club.
作者信息
Bergmann P, Body J-J, Boonen S, Boutsen Y, Devogelaer J-P, Goemaere S, Kaufman J-M, Reginster J-Y, Gangji V
机构信息
Laboratory of Clinical Chemistry, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium.
出版信息
Int J Clin Pract. 2009 Jan;63(1):19-26. doi: 10.1111/j.1742-1241.2008.01911.x.
OBJECTIVES
To review the clinical value of bone turnover markers (BTM), to initiate and/or monitor anti-resorptive treatment for osteoporosis compared with bone mineral density (BMD) and to evaluate suitable BTM and changes in BTM levels for significance of treatment efficiency.
METHODOLOGY
Consensus meeting generating guidelines for clinical practice after review and discussion of the randomised controlled trials or meta-analyses on the management of osteoporosis in postmenopausal women.
RESULTS
Although the correlation between BMD and BTM is statistically significant, BTM cannot be used as predictive markers of BMD in an individual patient. Both are independent predictors of fracture risk, but BTM can only be used as an additional risk factor in the decision to treat. Current data do not support the use of BTM to select the optimal treatment. However, they can be used to monitor treatment efficiency before BMD changes can be evaluated. Early changes in BTM can be used to measure the clinical efficacy of an anti-resorptive treatment and to reinforce patient compliance.
DISCUSSION
Determining a threshold of BTM reflecting an optimal long-term effect is not obvious. The objective should be the return to the premenopausal range and/or a decrease at least equal to the least significant change (30%). Preanalytical and analytical variability of BTM is an important limitation to their use. Serum C-terminal cross-linked telopeptide of type I collagen (CTX), procollagen 1 N terminal extension peptide and bone specific alkaline phosphatase (BSALP) appear to be the most suitable.
CONCLUSION
Consensus regarding the use of BTM resulted in guidelines for clinical practice. BMD determines the indication to treat osteoporosis. BTM reflect treatment efficiency and can be used to motivate patients to persist with their medication.
目的
回顾骨转换标志物（BTM）的临床价值，与骨密度（BMD）相比，启动和/或监测骨质疏松症的抗吸收治疗，并评估合适的BTM以及BTM水平变化对治疗效果意义的影响。
方法
在对绝经后妇女骨质疏松症管理的随机对照试验或荟萃分析进行回顾和讨论后，召开共识会议以制定临床实践指南。
结果
尽管BMD与BTM之间的相关性具有统计学意义，但BTM不能作为个体患者BMD的预测标志物。两者都是骨折风险的独立预测因素，但BTM只能作为治疗决策中的一个额外风险因素。目前的数据不支持使用BTM来选择最佳治疗方法。然而，在评估BMD变化之前，它们可用于监测治疗效果。BTM的早期变化可用于衡量抗吸收治疗的临床疗效并增强患者的依从性。
讨论
确定反映最佳长期效果的BTM阈值并不明显。目标应该是恢复到绝经前范围和/或至少降低至最小显著变化（30%）。BTM的分析前和分析变异性是其使用的一个重要限制。血清I型胶原C末端交联端肽（CTX）、前胶原1 N末端延长肽和骨特异性碱性磷酸酶（BSALP）似乎是最合适的。
结论
关于BTM使用的共识产生了临床实践指南。BMD决定骨质疏松症的治疗指征。BTM反映治疗效果，可用于促使患者坚持用药。
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