Loyola University Medical Center, Maywood, Illinois, USA.
Curr Opin Endocrinol Diabetes Obes. 2018 Dec;25(6):366-372. doi: 10.1097/MED.0000000000000446.
Osteoporosis is a common public health problem that is often undertreated and underdiagnosed. The clinical management of osteoporosis is often reactionary to devastating fracture events. Bone turnover markers may improve the ease and rapidity at which osteoporosis is monitored and treated. Bone turnover markers are biochemical byproducts of bone formation or bone resorption. The clinical use of bone turnover markers is limited by significant preanalytical variability. Effective interpretation of bone turnover markers requires a detailed understanding of the variables that can affect their responses to osteoporosis treatment and monitoring.
Progress is continuously being made on the standardization of bone turnover markers. The literature on the response of bone turnover markers to unique clinical situations is expanding. Data for evidence-based reference intervals for bone turnover markers has increased. Variables that affect the appropriate timing of lab draws like diurnal variation, postprandial status, exercise and alcohol use have been described. Studies examining the expected response of bone turnover markers to treatments of osteoporosis and other medications that affect bone health continue to increase.
Bone turnover markers have clinical utility in the comprehensive evaluation of osteoporosis. When interpreted with caution and with a good understanding of their natural variability, bone turnover markers provide information that supplements osteoporosis management and provides useful clinical information about conditions that alter bone turnover.
骨质疏松症是一种常见的公共健康问题，常被漏诊和治疗不足。骨质疏松症的临床管理通常是针对破坏性骨折事件做出的反应。骨转换标志物可以提高监测和治疗骨质疏松症的简便性和速度。骨转换标志物是骨形成或骨吸收的生化副产物。骨转换标志物的临床应用受到显著的分析前变异性的限制。要有效解读骨转换标志物，需要详细了解可能影响其对骨质疏松症治疗和监测反应的变量。
骨转换标志物的标准化工作不断取得进展。关于骨转换标志物对独特临床情况的反应的文献正在不断增加。用于骨转换标志物的基于证据的参考区间的数据也在增加。影响实验室检测时间的变量，如昼夜变化、餐后状态、运动和饮酒，已经被描述。研究继续增加，以探讨骨转换标志物对骨质疏松症治疗和其他影响骨骼健康的药物的预期反应。
骨转换标志物在骨质疏松症的综合评估中有临床应用价值。当谨慎解读并充分了解其自然变异性时，骨转换标志物可提供补充骨质疏松症管理的信息，并提供有关改变骨转换的情况的有用临床信息。
