Bone Markers
Bone is a living tissue that is constantly being destroyed and rebuilt. Bone destruction is done by osteoclast (osteoblastic) cells, and this is naturally balanced by the production of new bone by osteoblast cells. In people with bone destruction disorders such as osteoporosis, osteogenic cells retard the activity and progression of osteoclasts and reduce bone density.
Bone status can be assessed in a variety of ways, such as bone density, x-rays, and biochemical markers. Among these methods, biochemical markers of bone are much more sensitive. These tests are based on measuring the level of bone turnover markers. These bone markers are mainly the product of bone collagen degradation or specific enzymes related to osteoclasts or osteoblasts that increase their blood and urine levels during bone disorders.
These markers are widely used in the early detection and progression of metabolic bone diseases. Measurement of these markers is also useful in evaluating anti-osteoporosis treatment, especially in the first months after treatment. Many of these markers are currently identified.
Bone markers tests are as follows:
- N-MID Osteocalcin (one of the most important proteins of the matrix of the bone)
- Total PINP (Procollagen) (the most protein of the bone and made as a collagen)
- Beta-CrossLaps/Serum
bone marker
(Beta-CrossLaps (Beta-CTx)
(C-terminal telopeptide of type I collagen) or CTX or Beta-CrossLaps, a telopeptide originating from the carboxy-terminal portion of collagen type I degradation products. CTX is used as a proprietary marker in serum to evaluate bone turnover. This combination is a marker of bone resorption and its elevated concentration in serum and urine indicates increased bone resorption (bone resorption) in the patient.
- Increased levels of Beta-CrossLaps in hyperthyroidism, hyperparathyroidism, Paget’s disease, decreased bone density and osteoporosis.
- Beta-CrossLaps measurement is useful in evaluating the outcome of treatment in patients with reduced bone mineral density and osteoporosis, although it is necessary to measure its level before initiating treatment.
- A 2% decrease in CTX levels (3 to 6 months) after initiating anti-bone resorption treatments indicates an appropriate therapeutic response.
Normal values:
Male
4-5 years old: 2-4 pg grams per ml
4-5 years old: 2-4 pg grams per ml
4-5 years old: 2-4 pg grams per ml
Female
Before menopause: 2-4 pg / ml
Postmenopausal: 1-3 pico grams per ml
N-MID Osteocalcin
Osteocalcin is the most important non-collagen protein in bone matrix that has calcium binding ability. It is produced by osteoblasts and is one of the markers of bone formation.
- Osteocalcin levels are useful in evaluating treatment outcome in patients with reduced bone mineral density, Paget’s disease, hypercalcemia, and osteoporosis.
- Osteocalcin levels are reduced in diseases such as hypothyroidism, hypo-parathyroidism and growth hormone deficiency.
- Avoid multivitamins and dietary supplements containing biotin and vitamin B7 1 hour before the test.
Normal range:
children
4-5 years old: 2-4 ng / ml
4-5 years old: 2-4 ng / ml
male
2-5 years old: 1-2 ng / ml
Adults: 1–2 ng / ml
female
2-5 years old: 1-2 ng / ml
Adults: 1–2 ng / ml
(Total PINP (Procollagen)
Type I collagen is the most common type of collagen in the bone that is made by osteoblasts in the form of procollagen. Procollagen has two N-terminal propeptides (PINP) and a C-terminal (PICP). These propeptides are isolated by specific proteinases before collagen is formed and found in the bloodstream.
- PINP is the most sensitive marker of bone formation.
- The measurement of PINP is useful in evaluating the outcome of bone anabolic and anabolic treatments in patients with osteoporosis.
- PINP levels should not be used as a screening test for osteoporosis in the general population.
- PINP levels change during the day, for example, at night. So try to be at the same time of the day in your periodic tests.
- In patients with severe hepatic impairment, the liver may not be able to clear PINP from the bloodstream, leading to a false elevation of PINP levels.
normal range
male
1-2 micrograms per liter
female
Before menopause: 1-2 micrograms per liter
Postmenopausal: 1-2 micrograms per liter