Bone turnover assessment: a good surrogate marker?

Abstract

SummaryTo asses fracture risk, bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is the most commonly used tool. The search for clinical risk factors is also advised and can provide a 10-year fracture probability (FRAX model). Another important determinant of bone strength is bone remodeling. High bone remodeling rates have been associated with a higher fracture risk and bone turnover markers (BTM) may offer dynamic information about skeletal status independent of BMD. The efficacy of antiresorptive agents in fracture prevention goes beyond what can be predicted by BMD especially in the beginning of the treatment. Inhibition of bone remodeling itself is certainly an important mechanism by which antiresorptive agents can rapidly reduce fracture risk. Thus, it seems quite logical to use BTM in patients with bone disease. It can also become a valuable surrogate marker in fracture prediction. However, BTM's pre-analytical and analytical variability should always be considered. Arq Bras Endocrinol Metab. 2010;54(2):99-105 Keywords Bone turnover; biochemical markers; osteoporosis; fracture SumárioO método mais utilizado para avaliação do risco de fraturas é a densitometria óssea pela téc-nica de DXA (absorciometria por raios-X duo-energética). A pesquisa de condições clínicas de risco também é recomendada e fornece uma estimativa da probabilidade de fratura em 10 anos (modelo FRAX). Outro fator importante é o grau de remodelação óssea. Um aumento da taxa de remodelação tem sido associado a um maior risco de fraturas e aumento dos marcadores ósseos. A medida desses marcadores fornece informação adicional independente da densitometria. A eficiência das medicações antirreabsortivas na prevenção de fraturas não é explicada apenas pelo aumento da densidade óssea. A menor remodelação óssea é um mecanismo que pode explicar a redução da taxa de fraturas principalmente no início do tratamento. A utilização desses marcadores nas doenças ósseas e na predição de fraturas torna-se lógica. No entanto, para interpretá-los corretamente sua variação pré-analítica e analítica deve ser considerada. Arq Bras Endocrinol Metab. 2010;54(2):99-105 Descritores Remodelação óssea; marcadores ósseos; osteoporose; fratura

Effect of three months of periodized hydrogymnastics exercise program on urinary concentration of deoxypyridinoline in older women

“…Regarding the assessment of osteoporosis in elderly population urinary concentration of deoxypyridinoline was chosen for inexpensive, validated, easy to apply bone marker which have been identified as a good prediction by early change of bone metabolic markers of the efficacy of anti-osteoporotic drugs on bone mass in osteoporotic patients (13)(14)(15)(16). Strength exercise modalities have been showed better results in in biochemical markers of bone turnover (17,19,28) due the voluntary muscle contraction produces stress on bone morphology and the mechanical load resulting from the muscle contraction induced osteoblast formation and inhibits bone resorption (9) instead of aquatic exercises where the reduction of the gravity forces on human body when immersed in water makes and low high impact seem to be less osteogenic (29).…”

“…The deoxypyridinoline has been identified as a good prediction by early change of bone metabolic markers of the efficacy of anti-osteoporotic drugs on bone mass in osteoporotic patients (13)(14)(15)(16).…”

Osteopenia and osteoporosis among patients with human immunodeficiency virus infection

“…The bone production markers are procollagen I N-terminal propetide (PINP), procollagen I C-terminal propetide (PICP), bone alkaline phosphatase (b-ALP) and osteocalcin (OC). The bone resorption markers are cross-linked C-terminal telopeptide (CTX), cross-linked Nterminal telopeptide (NTX), hydroxyproline (OHP), pyridinoline (PYD), deoxypyridinoline (DPD), carboxy-terminal telopeptide of type I collagen (ICTP), tartrate-resistant acid phosphatase b (TRAPb) and bone sialoprotein (BSP) [27].…”

Are Bone Turnover Markers Related with Fracture Risk in Initial Diagnose Postmenopausal Osteoporosis? A Cross-Sectional Clinical Study

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