Adachi J D
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Calcif Tissue Int. 1996;59 Suppl 1:16-9. doi: 10.1007/s002239900170.
Bone metabolism may be measured indirectly by determining markers for bone formation and bone resorption. Traditionally, total alkaline phosphatase has served to mark bone formation, whereas urine calcium and hydroxyproline, corrected for creatinine, have marked bone resorption. Although these markers have contributed to our understanding of bone metabolism, by themselves they lack the sensitivity and specificity to be helpful in the day-to-day management of patients with osteoporosis. Newer bone markers have been developed and others are currently under development. These markers may be helpful in determining the type of osteoporosis and the response to therapy. Nonetheless, despite their increased sensitivity and specificity, they have not yet been shown to predict future fractures. Many prospective studies have shown that bone mass measured at any site and by any method is inversely related to fracture risk. Site-specific measurement of the bone density of the proximal femur appears to have a stronger relationship to the risk of hip fracture. In predicting spinal fractures, however, measurement of bone density in the lumbar spine does not appear to be substantially superior to measurements of bone density at other sites. The lifetime risk for hip fracture can be estimated from bone mass measurements made in the perimenopausal period. In the future, the combination of baseline perimenopausal bone density and assessments of biochemical markers may better predict future fracture risk; however, this has yet to be shown.
骨代谢可以通过测定骨形成和骨吸收的标志物来间接衡量。传统上，总碱性磷酸酶用于标记骨形成，而校正肌酐后的尿钙和羟脯氨酸则用于标记骨吸收。尽管这些标志物有助于我们理解骨代谢，但就其本身而言，它们缺乏敏感性和特异性，对骨质疏松症患者的日常管理并无帮助。新型骨标志物已经研发出来，还有一些正在研发中。这些标志物可能有助于确定骨质疏松症的类型以及对治疗的反应。然而，尽管它们的敏感性和特异性有所提高，但尚未被证明能预测未来骨折。许多前瞻性研究表明，通过任何部位和任何方法测量的骨量与骨折风险呈负相关。股骨近端特定部位的骨密度测量似乎与髋部骨折风险的关系更为密切。然而，在预测脊柱骨折时，腰椎骨密度测量似乎并不明显优于其他部位的骨密度测量。髋部骨折的终生风险可以根据围绝经期进行的骨量测量来估计。未来，围绝经期基线骨密度与生化标志物评估相结合可能会更好地预测未来骨折风险；然而，这一点尚未得到证实。
