Knochenumbaumarker

V. Schwetz; B. Obermayer-Pietsch

doi:10.1055/s-0037-1622068

Osteologie, Table of Contents

Osteologie 2015; 24(04): 215-218
DOI: 10.1055/s-0037-1622068

Labordiagnostik bei metabolischen Knochenerkrankungen

Schattauer GmbH

Knochenumbaumarker

Übersicht und klinische BedeutungMarkers of bone turnover Overview and clinical significance

Authors

V. Schwetz

¹Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
B. Obermayer-Pietsch

¹Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich

Abstract

Zusammenfassung

Knochenumbauparameter können zusätzliche Informationen zur Abschätzung der Dynamik des Knochenstoffwechsels in der Osteoporosediagnostik nebst Knochendichte, den klinischen Daten und Routine-Laborparametern liefern. Zu den Aufbaumarkern des Knochenstoffwechsels zählen Prokollagen Typ 1 N-terminales Propeptid (P1NP), die knochenspezifische alkalische Phosphatase (bALP) und Osteokalzin (OC), zu den Abbaumarkern des Knochenstoffwechsels gehören Pyridinolin (PYD) und Desoxypyridinolin (DPD), N-terminales Kollagen-Typ-I-Telopeptid (NTX) und C-terminales Kollagen-Typ-ITelopeptid (CTX), β-CrossLaps (β-CTX), die Tartrat-resistent saure Phosphatase (TRAP5b) sowie Cathepsin K. Das Einsatzgebiet liegt vor allem in der Verlaufsbeurteilung nach Einleitung einer Osteoporosetherapie und im Compliance-Monitoring. Knochenumbaumarker stellen jedoch derzeit keine alleinige Entscheidungsgrundlage zur Initiierung einer Therapie dar. In der Hämatoonkologie scheinen hohe Knochenabbaumarker mit einem höheren Rezidivrisiko bzw. einem höheren Risiko für skelettassoziierte Ereignisse verbunden zu sein.

Summary

Parameters assessing bone turnover may provide additional information in the diagnosis of osteoporosis, adding to bone mineral density, clinical data and routine laboratory. Parameters of bone formation include procollagen type 1 N-terminal propeptide (P1NP), bone-specific alkaline phosphatase (bALP) and osteocalcin (OC). Parameters of bone resorption are pyridinoline (PYD) and desoxypyridinoline (DPD), N-terminal collagen type I-telopeptide (NTX) and C-terminal collagen type I-telopeptide (CTX), β-crosslaps (β-CTX), tartrate-resistant acid phosphatase (TRAP5b) as well as cathepsin K. The clinical utility lies especially in the monitoring of bone turnover after initiation of osteoporosis therapy to evaluate treatment efficacy and in the monitoring of patient compliance, while the decision to commence treatment cannot be based solely on bone turnover markers alone. In haemato-oncology, high bone turnover markers, especially high parameters of bone resorption, are associated with a higher risk for skeletal-related events.

Schlüsselwörter

P1NP - Osteokalzin - CrossLaps

Keywords

P1NP - osteocalcin - crosslaps

Full Text

References

Literatur
1 Vasikaran S, Eastell R, Bruyere O. et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 2011; 22 (02) 391-420.
2 Bieglmayer C, Dimai HP, Gasser RW. et al. Biomarkers of bone turnover in diagnosis and therapy of osteoporosis: a consensus advice from an Austrian working group. Wien Med Wochenschr 2012; 162 (21–22): 464-477.
3 Schwetz V, Pieber T, Obermayer-Pietsch B. The endocrine role of the skeleton: background and clinical evidence. Eur J Endocrinol 2012; 166 (06) 959-967.
4 Ferron M, Wei J, Yoshizawa T. et al. Insulin signaling in osteoblasts integrates bone remodeling and energy metabolism. Cell 2010; 142 (02) 296-308.
5 Lee NK, Sowa H, Hinoi E. et al. Endocrine regulation of energy metabolism by the skeleton. Cell 2007; 130 (03) 456-469.
6 Akesson K, Kakonen SM, Josefsson PO. et al. Fracture-induced changes in bone turnover: a potential confounder in the use of biochemical markers in osteoporosis. J Bone Miner Metab 2005; 23 (01) 30-35.
7 Watts NB. Clinical utility of biochemical markers of bone remodeling. Clin Chem 1999; 45 (8 Pt 2): 1359-1368.
8 Civitelli R, Armamento-Villareal R, Napoli N. Bone turnover markers: understanding their value in clinical trials and clinical practice. Osteoporos Int 2009; 20 (06) 843-851.
9 Delmas PD, Eastell R, Garnero P. et al. Committee of Scientific Advisors of the International Osteoporosis Foundation. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 2000; 11 (Suppl. 06) S2-S17.
10 Garnero P, Borel O, Delmas PD. Evaluation of a fully automated serum assay for C-terminal crosslinking telopeptide of type I collagen in osteoporosis. Clin Chem 2001; 47 (04) 694-702.
11 Halleen JM, Alatalo SL, Janckila AJ. et al. Serum tartrate-resistant acid phosphatase 5b is a specific and sensitive marker of bone resorption. Clin Chem 2001; 47 (03) 597-600.
12 Novinec M, Lenarcic B. Cathepsin K: a unique collagenolytic cysteine peptidase. Biol Chem 2013; 394 (09) 1163-1179.
13 Bauer DC, Sklarin PM, Stone KL. et al. Biochemical markers of bone turnover and prediction of hip bone loss in older women: the study of osteoporotic fractures. J Bone Miner Res 1999; 14 (08) 1404-1410.
14 Lenora J, Ivaska KK, Obrant KJ, Gerdhem P. Prediction of bone loss using biochemical markers of bone turnover. Osteoporos Int 2007; 18 (09) 1297-1305.
15 Garnero P, Sornay-Rendu E, Claustrat B, Delmas PD. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res 2000; 15 (08) 1526-1536.
16 van Daele PL, Seibel MJ, Burger H. et al. Case-control analysis of bone resorption markers, disability, and hip fracture risk: the Rotterdam study. BMJ 1996; 312 (7029) 482-483.
17 Saag K, Lindsay R, Kriegman A. et al. A single zoledronic acid infusion reduces bone resorption markers more rapidly than weekly oral alendronate in postmenopausal women with low bone mineral density. Bone 2007; 40 (05) 1238-1243.
18 Recker R, Stakkestad JA, Chesnut 3rd CH. et al. Insufficiently dosed intravenous ibandronate injections are associated with suboptimal antifracture efficacy in postmenopausal osteoporosis. Bone 2004; 34 (05) 890-899.
19 Bauer DC, Garnero P, Hochberg MC. et al. Pretreatment levels of bone turnover and the antifracture efficacy of alendronate: the fracture intervention trial. J Bone Miner Res 2006; 21 (02) 292-299.
20 Black DM, Delmas PD, Eastell R. et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007; 356 (18) 1809-1822.
21 Cummings SR, San JMartin, McClung MR. et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009; 361 (08) 756-765.
22 Bone HG, Bolognese MA, Yuen CK. et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 2011; 96 (04) 972-980.
23 Langdahl B, Binkley N, Bone H. et al. Odanacatib in the treatment of postmenopausal women with low bone mineral density: five years of continued therapy in a phase 2 study. J Bone Miner Res 2012; 27 (11) 2251-2258.
24 Black DM, Schwartz AV, Ensrud KE. et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Longterm Extension (FLEX): a randomized trial. JAMA 2006; 296 (24) 2927-2938.
25 Black DM, Reid IR, Boonen S. et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012; 27 (02) 243-254.
26 Russell RG, Rogers MJ. Bisphosphonates: from the laboratory to the clinic and back again. Bone 1999; 25 (01) 97-106.
27 Clowes JA, Peel NF, Eastell R. The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 2004; 89 (03) 1117-1123.
28 Lipton A, Chapman JA, Demers L. et al. Elevated bone turnover predicts for bone metastasis in postmenopausal breast cancer: results of NCIC CTG MA.14. J Clin Oncol 2011; 29 (27) 3605-3610.
29 Terpos E, Berenson J, Cook RJ. et al. Prognostic variables for survival and skeletal complications in patients with multiple myeloma osteolytic bone disease. Leukemia 2010; 24 (05) 1043-1049.