Garnero P, Delmas P D
INSERM Research Unit 403, Hôpital E. Herriot, Pavillion F, 69437 Lyon Cedex 03, Lyon, France.
Calcif Tissue Int. 1996;59 Suppl 1:S2-9. doi: 10.1007/s002239900168.
The noninvasive assessment of bone turnover has markedly improved in the past few years with the development of sensitive and specific markers of bone formation and bone resorption. Markers of bone formation in serum include total and bone-specific alkaline phosphatase, osteocalcin, and type I collagen carboxyterminal extension peptide. Assessment of bone resorption can be achieved by measuring plasma tartrate-resistant acid phosphate and the urinary excretion (and possibly serum levels) of bone type I collagen degradation products: hydroxyproline, hydroxylysine glycosides, and, more recently, the pyridinium crosslinks (pyridinoline and deoxypyridinoline) and associated peptides. The immunoassay of human osteocalcin and bone alkaline phosphatase for formation and the pyridinoline crosslinks measured by high-pressure liquid chromatography or by immunoassay for bone resorption are currently the most sensitive and specific markers of bone turnover for the clinical assessment of osteoporosis. Using these new markers, several studies have shown that bone turnover increases after the menopause and remains elevated in late postmenopausal and elderly women. An increased bone turnover rate is related to a high rate of bone loss in postmenopausal women and to a decreased bone mass in elderly women. Recent data suggest that some of the new immunoassays for pyridinoline crosslinks could predict the subsequent risk of hip fracture in elderly women. Thus, bone markers might be used in combination with bone mass measurement to improve the prognostic assessment of postmenopausal women, i.e., their risk of developing osteoporosis and ultimately fractures. Treatment of postmenopausal women with antiresorptive drugs such as estrogens, bisphosphonates, and calcitonin induces a rapid decrease in the levels of bone markers that is correlated with the long-term effect of such treatments on bone mass. Thus, bone markers should be very useful in monitoring treatment efficacy in patients with osteoporosis.
在过去几年中，随着敏感且特异的骨形成和骨吸收标志物的发展，骨转换的无创评估有了显著改善。血清中的骨形成标志物包括总碱性磷酸酶和骨特异性碱性磷酸酶、骨钙素以及I型胶原羧基末端延长肽。骨吸收的评估可通过测量血浆抗酒石酸酸性磷酸酶以及骨I型胶原降解产物的尿排泄量（可能还有血清水平）来实现：羟脯氨酸、羟赖氨酸糖苷，以及最近的吡啶交联物（吡啶啉和脱氧吡啶啉）及其相关肽。目前，用于骨形成评估的人骨钙素和骨碱性磷酸酶免疫测定法，以及用于骨吸收评估的通过高压液相色谱法或免疫测定法测量的吡啶啉交联物，是用于骨质疏松症临床评估的最敏感且特异的骨转换标志物。使用这些新标志物的多项研究表明，绝经后骨转换增加，并在绝经后期和老年女性中持续升高。骨转换率增加与绝经后女性的高骨丢失率以及老年女性的骨量减少有关。最近的数据表明，一些针对吡啶啉交联物的新免疫测定法可预测老年女性随后发生髋部骨折的风险。因此，骨标志物可与骨量测量结合使用，以改善对绝经后女性的预后评估，即她们发生骨质疏松症及最终骨折的风险。用抗吸收药物如雌激素、双膦酸盐和降钙素治疗绝经后女性会导致骨标志物水平迅速下降，这与此类治疗对骨量的长期影响相关。因此，骨标志物在监测骨质疏松症患者的治疗效果方面应该非常有用。
