课件：骨转化指标.ppt

* 随着年龄的变化，人的骨转换率也是不断变化的，从绝经开始到60岁左右，也就是绝经后骨质疏松期，骨转换率是高于正常水平的，此时骨形成和骨吸收同时增加，而骨吸收增加的幅度要超过骨形成，所以导致骨量丢失，此阶段治疗主要是以抑制骨吸收的药物为主；而到60岁以后，也就是到了老年期，股转换开始下降，并低于正常水平，此时骨形成和骨吸收同时减少，但骨形成减少的程度要大于骨吸收，还是导致骨量丢失，这时，其治疗就应该以促进骨形成的药物为主。 * 用BMD评估治疗的效果需要在大约在治疗开始后两年 * * Response of biochemical markers of bone turnover to hormone replacement therapy: impact of biological variability. J Bone Miner Res. 1998 Jul;13(7):1124-33 Hannon R, Blumsohn A, Naylor K, Eastell R. Department of Human Metabolism and Clinical Biochemistry, University of Sheffield, United Kingdom. Biochemical markers of bone turnover may be useful to monitor patients taking hormone replacement therapy (HRT). The aim of this study was to assess the utility of markers in monitoring HRT by comparing the response of a large panel of markers to HRT with their within subject variability. We measured the response of markers to transdermal estradiol in 11 postmenopausal women over 24 weeks. We measured the within subject variability of markers in 11 untreated healthy postmenopausal women over the same period. The mean decrease in markers of bone formation after 24 weeks treatment ranged from 19% for procollagen type I C-terminal propeptide (PICP) to 40% for procollagen type I N-terminal propeptide (PINP). The mean decrease in markers of bone resorption ranged from 10% for tartrate-resistant acid phosphatase (TRAP) to 67% for C-terminal cross-linked telopeptide The least significant change (LSC at p 0.05), calculated from the within subject variability in the untreated group, was used to define response. LSC for osteocalcin was 21%, bone alkaline phosphatase 28%, PICP 24%, PINP 21%, type I collagen telopeptide 28%, TRAP 17%, urinary calcium 90%, hydroxyproline 75%, total deoxypyridinoline 47%, free pyridinoline 36%, free deoxypyridinoline 26%, N-terminal cross-linked telopeptide 70%, and C-terminal cross-linked telopeptide 132%. The greatest number of responders after 24 weeks of treatment were found using PINP and osteocalcin (9 e