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Meaning
Osteoporosis
Severe or
BMD is reduced below -2,5 SD
established in the presence of fracture
osteoporosis
BMD Classification
BMD
Osteopen
ia
1,0
Osteoporosis
2,5
S
D
A laboratory test cannot replace bone densitometry, because the two procedures
provide different types of information perse.
Bone densitometry indicates the current level of bone density at that time.
The laboratory test represents the process of bone reformation and therefore
provides information about a potential imbalance between bone formation and
resorption.
The laboratory parameter also provides information about the kinetics of bone
metabolism
The two methods complement each other
Risk Factors
Bone Turnover
Characterized by 2 metabolic processes :
Osteocalcin
Bone Specific Alkaline Phosphatase or Isoenzyme Alkaline Phosphatase
Pyridinoline Crosslink
Deoxypyridinoline Crosslink
C-Telopeptida (CTx, Cross Laps)
N-Telopeptida (NTx, Osteomark)
OSTEOCALCIN
-
Synthesized by osteoblast
Its production is dependent upon vitamin K (formation of -Carboxyglutamic
acid residues) and is stimulated by vitamin D3
Osteocalcin level is related to the rate of bone turnover in various disorders of
bone metabolism
Osteocalcin Degradation
CROSSLINK
Free :
Free pyridinoline crosslink (Pyd)
Free deoxypyridinoline crosslink (Dpd)
Peptide :
N-telopeptide (NTx, Osteomark)
C-telopeptide (CTx, Crosslaps)
Collagen Crosslinks
low
high
Fracture
risk
Bone
Resorp
tion
Marker
renda
h
Fracture
risk
norm
al
Bone
Resorpt
ion
Marker
high
low
Fracture
risk
Fracture
risk
+++
++
--
++
treatment
treatment3)
No
treatment2)
treatment1)
2)
3)
Biochemical Markers
Bone markers might be used in combination with BMD to improve the prognostic
assessment of post menopausal women i.e. their risk of developing osteporosis and
ultimately fractures
Kecepatan kehilangan tulang pada wanita post menopause dapat diukur secara
tidak langsung dengan pengukuran penanda biokimia
Massa tulang yang rendah dan kecepatan kehilangan tulang yang besar
mempunyai peran yang sama besar untuk risiko fraktur di masa depan
Higher baseline levels of bone formation and bone resorption markers baseline
were significantly associated with faster BMD loss, independently of age
Women with an abnormally high bone turnover (bone markers at baseline > 2SD
above the mean of premenopausal woman) had a rate of bone loss that was 2-6x
higher than women with a low turnover according to the marker
High Bone Turnover
Baseline levels of bone markers > 2 SD
Above the mean of premenopausal
women
Rate of bone loss 2-6 x
>> low bone turnover
Bone markers display therapy response when determined before and a few
months after start of treatment.
Bone markers reflect therapy response already after 3 months, which is drastically
sooner than the BMD with the waiting period is 2 years to measure therapeutic
response.