Biomarkers of bone health and osteoporosis risk
Biomarkers of bone health and osteoporosis risk
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DOI：
10.1017/s002966510800699x
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发表时间：
2008-05-01
影响因子：
7
通讯作者：
Hannon, Rosemary A.
中科院分区：
文献类型：
--
作者：
Eastell, Richard;Hannon, Rosemary A.
近年来，骨转换生化标志物的检测特性有了明显的提高。骨形成的最敏感和特异性标志物包括血清骨碱性磷酸酶、总骨钙素（包括完整分子和大的N-中间片段）和I型前胶原N-末端前肽测定。在骨吸收的各种标志物中，N-和C-末端交联端肽的尿排泄和血清C-末端交联端肽的测量是最灵敏和特异的。骨转换标志物可用于预测绝经后妇女的骨丢失率，也可用于评估骨折风险。在骨质疏松治疗研究（阿仑膦酸钠、利塞膦酸钠、雷洛昔芬）中，骨转换标志物与骨折风险降低的相关性似乎比骨矿物质密度（BMD）更强。这些观察结果支持使用骨转换标志物作为骨折风险降低的替代物，甚至可能比BMD更有效。骨标志物还可用于监测抗吸收治疗（例如激素替代治疗、雷洛昔芬和双磷酸盐）对个体患者的疗效。此外，它们还被证明有助于监测对营养干预的反应，并且与BMD相比具有优势，因为它们提供了有关作用机制的信息，并且通常可以更快地观察到变化。
The assay features of biochemical markers of bone turnover have markedly improved in the past few years. The most sensitive and specific markers of bone formation include serum bone alkaline phosphatase, total osteocalcin (including the intact molecule and the large N-mid fragment) and the procollagen type I N-terminal propeptide assay. Among the various markers of bone resorption, measurements of the urinary excretion of N- and C-terminal cross-linked telopeptides) and of serum C-terminal cross-linked telopeptides are the most sensitive and specific. Markers of bone turnover can be used to predict the rate of bone loss in postmenopausal women and can also be used to assess the risk of fractures. In osteoporosis-treatment studies (with alendronate, risedronate, raloxifene) markers of bone turnover appear even more strongly associated with fracture risk reduction than bone mineral density (BMD). These observations support the use of markers of bone turnover as surrogates for fracture risk reduction, perhaps even more so than BMD. Bone markers can also be used to monitor the efficacy of antiresorptive therapy such as hormone-replacement therapy, raloxifene and bisphosphonates in individual patients. Furthermore, they have also proved to be helpful in monitoring the response to nutritional interventions and have the advantage over BMD in that they provide information about mechanism of effect and changes are often observed much more rapidly.