New developments in biochemical markers for osteoporosis
New developments in biochemical markers for osteoporosis
复制标题
DOI：
10.1007/s002239900168
复制
发表时间：
1996-01-01
影响因子：
4.2
通讯作者：
Delmas, PD
中科院分区：
文献类型：
--
作者：
Garnero, P;Delmas, PD
在过去的几年里，随着骨形成和骨吸收的敏感和特异性标志物的发展，骨转换的无创评估有了显著的改善。血清中骨形成的标志物包括总碱性磷酸酶和骨特异性碱性磷酸酶、骨钙素和I型胶原羧基末端延伸肽。骨吸收的评估可以通过测量血浆抗酒石酸磷酸酯和尿排泄（可能还有血清水平）骨I型胶原降解产物：羟脯氨酸、羟赖氨酸苷，以及最近的吡啶交联（吡啶啉和脱氧吡啶啉）和相关肽来实现。人骨钙素和骨碱性磷酸酶形成的免疫测定以及通过高压液相色谱法或骨吸收免疫测定测定的吡啶啉交联是目前临床评估骨质疏松症最敏感、最特异的骨转换标志物。利用这些新的标记物，一些研究表明，骨转换在绝经后增加，并在绝经后晚期和老年妇女中保持升高。骨周转率的增加与绝经后妇女的高骨质流失率和老年妇女的骨量减少有关。最近的数据表明，一些新的吡啶交联免疫分析方法可以预测老年妇女髋部骨折的风险。因此，骨标志物可能与骨量测量结合使用，以改善绝经后妇女的预后评估，即她们发生骨质疏松症和最终骨折的风险。绝经后妇女用抗吸收药物治疗，如雌激素、双膦酸盐和降钙素，可引起骨标志物水平的迅速下降，这与此类治疗对骨量的长期影响有关。因此，骨标志物在监测骨质疏松患者的治疗效果方面应该是非常有用的。
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.