骨重建的生物力学标记物BiochemicalMarkersofBoneRemodeling.docVIP

Biochemical Markers of Bone Remodeling The skeleton constantly undergoes a process of remodeling that is essential for bone health. Bone remodeling is a coupled process that begins with resorption of old bone by osteoclasts, followed by the formation of new bone by osteoblasts. Beginning in middle age or earlier, bone loss occurs because resorption exceeds formation, a fact that was identified over 50 years ago by Dr. Alton Fuller, the father of metabolic bone disease. He noted that postmenopausal women had elevated urinary calcium levels and deduced that this reflects a negative calcium balance that can result in osteoporotic fractures. Estrogen deficiency and many other diseases and conditions accentuate bone resorption Watts, 1999 . Three major diagnostic procedures are available to monitor bone turnover and evaluate metabolic bone disease: bone imaging techniques, bone biopsy, and biochemical markers of bone turnover. While bone density measurement is an important diagnostic tool in osteoporosis, it is difficult for the test to detect increased bone turnover in its early stages or to monitor acute changes. Also, bone densitometry gives a summated measure of mineralized bone matrix; it does not define abnormal distribution of bone loss. Bone biopsy can define the distribution of bone mass and can answer questions about bone mineralization not able to be answered with bone densitometry. However, bone biopsy is invasive and, in the absence of mineralization defects, it provides a relatively static glimpse into long and slowly developing processes; it is not useful in routine clinical management of osteoporosis. In osteoporosis, net bone loss is caused by only a slight imbalance of bone resorption over formation, so conventional markers, such as calcium and PTH, are usually normal. In contrast, bone turnover markers are more sensitive to subtle change and can be used to noninvasively detect and monitor progression of metabolic bone disease. Laboratory assessment