Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., PO Box 8301, St. Louis, MO 63110, USA.
Osteoporos Int. 2009 Jun;20(6):843-51. doi: 10.1007/s00198-009-0838-9. Epub 2009 Feb 4.
While bone mineral density (BMD) by dual-energy X-ray absorptiometry is the primary method of determining fracture risk, assessing bone turnover may add valuable information for the management of patients with low bone mass. Bone turnover markers (BTMs) are used in clinical trials where they can provide essential information on the biological efficacy of osteoporosis treatments. In such population-based studies, BTMs can predict fracture risk independent of BMD. When combined with BMD, they improve the fracture risk estimate above and beyond BMD alone in postmenopausal osteoporotic women. Since changes in bone turnover after the initiation of therapy with bone resorption inhibitors occur much more rapidly than changes in BMD, treatment efficacy could, in theory, be determined within weeks of using BTMs. However, such predictive value is limited by the large biological variability of these biochemical markers, even though newer automated methods have reduced their analytical variability. Consequently, widespread adoption as a means of predicting treatment efficacy in fracture prevention for individual patients cannot yet be recommended. BTMs may be useful for monitoring adherence to antiresorptive therapy and may aid in identifying patients for whom antiresorptive therapy is most appropriate. Thus, although BTMs are currently confined to clinical research applications, further improvement in assay precision may extend their diagnostic value in clinical settings.
虽然双能 X 射线吸收法测定的骨密度（BMD）是确定骨折风险的主要方法，但评估骨转换可能会为低骨量患者的管理提供有价值的信息。骨转换标志物（BTM）用于临床试验中，可提供骨质疏松症治疗的生物学疗效的重要信息。在这种基于人群的研究中，BTM 可独立于 BMD 预测骨折风险。当与 BMD 联合使用时，它们可提高绝经后骨质疏松症妇女的骨折风险估计值，超过 BMD 单独使用的效果。由于骨吸收抑制剂治疗开始后骨转换的变化比 BMD 的变化快得多，因此理论上可以在使用 BTM 后数周内确定治疗效果。然而，这种预测价值受到这些生化标志物的生物学变异性大的限制，尽管新型自动化方法降低了其分析变异性。因此，作为预测个体患者骨折预防治疗效果的手段，目前还不能广泛推荐。BTM 可用于监测抗吸收治疗的依从性，并有助于确定最适合抗吸收治疗的患者。因此，尽管 BTM 目前仅限于临床研究应用，但分析精密度的进一步提高可能会扩展其在临床环境中的诊断价值。
