Department of Clinical Biochemistry, PathWest Fiona Stanley Hospital Network, Murdoch, Western Australia, Australia; School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia.
Department of Clinical Biochemistry, PathWest Fiona Stanley Hospital Network, Murdoch, Western Australia, Australia.
Clin Chim Acta. 2018 Jun;481:161-170. doi: 10.1016/j.cca.2018.03.009. Epub 2018 Mar 12.
Bone turnover marker (BTMs) concentrations in blood and urine reflect bone-remodelling activity, and may be useful adjuncts in the diagnosis and management of metabolic bone diseases. Newer biomarkers, mainly bone regulatory proteins, are currently being investigated to elucidate their role in bone metabolism and disease and may in future be useful in clinical diagnosis and management of metabolic bone disease. BTM concentrations increase around menopause in women, and at a population level the degree of increase in BTMs reflect bone loss. However, lack of adequate data precludes their use in individual patients for fracture risk assessment in clinical practice. The rapid and large changes in BTMs following anti-resorptive and anabolic therapies for osteoporosis treatment indicate they may be useful for monitoring therapy in clinical practice. The offset of drug effect on BTMs could be helpful for adjudicating the duration of bisphosphonate drug holidays. BTMs may offer useful additional data in skeletal diseases that are typically characterised by increased bone remodelling: chronic kidney disease (CKD), primary hyperparathyroidism (PHPT) and Paget's disease. In CKD, bone specific alkaline phosphatase (bAP) is currently endorsed for use for the assessment of mineral bone disease. The role of BTMsin predicting the bone mineral density response to successful parathyroidectomy in PHPT shows some utility but the data are not consistent and studies are limited in size and/or duration. In Paget's disease of bone, BTMs are used to confirm diagnosis, evaluate extent of disease or degree of activity and for monitoring the response to bisphosphonate treatment. Whilst BTMs are currently used in specific clinical practice instances when investigating or managing metabolic bone disease, further data are needed to consolidate their clinical use where evidence of utility is limited.
骨转换标志物 (BTMs) 在血液和尿液中的浓度反映了骨重塑活性，并且可能有助于代谢性骨病的诊断和管理。目前正在研究新的生物标志物，主要是骨调节蛋白，以阐明它们在骨代谢和疾病中的作用，并且将来可能有助于代谢性骨病的临床诊断和管理。女性在绝经前后 BTM 浓度增加，在人群水平上，BTMs 的增加程度反映了骨丢失。然而，由于缺乏足够的数据，在临床实践中无法将其用于评估个体患者的骨折风险。抗吸收和促合成治疗骨质疏松症后 BTMs 的快速和大量变化表明，它们可能有助于监测临床实践中的治疗。药物对 BTMs 作用的抵消可能有助于判断双膦酸盐药物假期的持续时间。BTMs 可能为骨骼疾病提供有用的额外数据，这些疾病通常以骨重塑增加为特征：慢性肾脏病 (CKD)、原发性甲状旁腺功能亢进症 (PHPT) 和 Pagets 病。在 CKD 中，骨特异性碱性磷酸酶 (bAP) 目前被推荐用于评估矿物质骨疾病。BTMs 在预测 PHPT 甲状旁腺切除术成功后骨密度反应中的作用显示出一定的实用性，但数据不一致，并且研究在规模和/或持续时间上有限。在 Pagets 病中，BTMs 用于确认诊断、评估疾病程度或活动程度以及监测双膦酸盐治疗的反应。尽管 BTMs 目前在代谢性骨病的调查或管理中用于特定的临床实践情况，但需要进一步的数据来巩固其在证据有限的情况下的临床应用。
