Vasikaran Samuel D, Miura Masakazu, Pikner Richard, Bhattoa Harjit P, Cavalier Etienne
PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia.
Faculty of Pharmaceutical Sciences, Hokuriku University/Hokuriku University Healthy Aging Research Group, 3 Ho Kanagawa-machi, Kanazawa City, Ishikawa, 9201181, Japan.
Calcif Tissue Int. 2023 Feb;112(2):148-157. doi: 10.1007/s00223-021-00930-4. Epub 2021 Nov 30.
Bone turnover markers (BTMs) are released during the bone remodelling cycle and are measurable in blood or urine, reflecting bone remodelling rate. They have been useful in elucidating the pharmacodynamics and effectiveness of osteoporosis medication in clinical trials and are increasingly used in routine clinical management of osteoporosis, especially for monitoring therapy, in addition to their use in other metabolic bone disease such as Paget's disease of bone and osteomalacia. Serum β isomerised C-terminal telopeptide of type I collagen and pro-collagen I N-terminal propeptide have been designated as reference BTMs for use in osteoporosis. In addition, bone-specific isoenzyme of alkaline phosphatase (B-ALP) secreted by osteoblasts and tartrate-resistant acid phosphatase 5b (TRACP-5b) secreted by osteoclasts are also found to be specific markers of bone formation and resorption, respectively. The concentrations of the latter enzymes in blood measured by immunoassay provide reliable measures of bone turnover even in the presence of renal failure. B-ALP is recommended for use in the assessment of renal bone disease of chronic kidney disease, and TRACP-5b shows promise as a marker of bone resorption in that condition. BTMs in blood do not suffer from biological variation to the same extent as the older BTMs that were measured in urine. Appropriate patient preparation and sample handling are important in obtaining accurate measures of BTMs for clinical use. Reference change values and treatment targets have been determined for the reference BTMs for their use in monitoring osteoporosis treatment. Further ongoing studies will enhance their clinical applications.
骨转换标志物（BTMs）在骨重塑周期中释放，可在血液或尿液中检测到，反映骨重塑速率。它们在阐明骨质疏松症药物在临床试验中的药效学和有效性方面很有用，并且越来越多地用于骨质疏松症的常规临床管理，特别是用于监测治疗，此外还用于其他代谢性骨病，如骨Paget病和骨软化症。血清I型胶原β异构化C末端肽和I型前胶原N末端前肽已被指定为用于骨质疏松症的参考BTMs。此外，成骨细胞分泌的碱性磷酸酶骨特异性同工酶（B-ALP）和破骨细胞分泌的抗酒石酸酸性磷酸酶5b（TRACP-5b）也分别被发现是骨形成和骨吸收的特异性标志物。即使在存在肾衰竭的情况下，通过免疫测定法测量血液中后一种酶的浓度也能提供可靠的骨转换指标。B-ALP推荐用于评估慢性肾脏病的肾性骨病，TRACP-5b有望作为该病症中骨吸收的标志物。血液中的BTMs不像在尿液中测量的较老的BTMs那样受到相同程度的生物学变异影响。适当的患者准备和样本处理对于获得用于临床的准确BTM测量值很重要。已经确定了参考BTMs在监测骨质疏松症治疗中的参考变化值和治疗目标。正在进行的进一步研究将增强它们的临床应用。
