Biochemical diagnosis of osteoporosis .Markers of osteoporosis - Causes, Symptoms and Treatment .MF .
early biochemical diagnosis of osteoporosis.
main purpose of the application of biochemical osteoporosis markers consists mainly in the fact that they can assess bone metabolism, which is very important for the choice of treatment and evaluation of treatment outcomes as patients with osteoporosis and high levels of bone metabolism is much more responsive to such active antiresorptive agentsas estrogen and calcitonin.If bone turnover figures correspond to the lower third of the normal range or even lower, a significant therapeutic effect is unlikely.
Biochemical markers are also used to address the issue of the need for drug therapy in postmenopausal women: the higher values of bone metabolism and lower the value of bone density compared with normal values, the greater the need for the appointment of drug therapy.Determination of bone metabolic activity, can allow the physician to adjust the therapy to be assigned to the final confirmation of the diagnosis densitometric methods.
results of many clin
Identifying markers of osteoporosis, unlike some instrumental methods are not associated with exposure to the organism.
Determining level of biochemical markers of bone resorption and bone remodeling allows you to:
- Prophylactic examination to identify patients with metabolic disorders and remodeling processes of bone resorption;
- Rate and make a forecast of the level of bone loss;
- an objective assessment of the effectiveness of the prescribed treatment within two months;
- Select the most effective drug in a particular case and to determine the optimal dose for each patient individually.
In biochemical diagnostics estimate the rate of formation and destruction of bone tissue.This suggests that the prevalence of bone fracture rates over the performance of its formation indicates the development of osteoporosis or lack of effectiveness of its treatment.
Biochemical markers of bone remodeling
Alkaline phosphatase of bone origin contained in the membrane of osteoblasts.As an indicator of remodeling most frequently used common alkaline phosphatase activity in the serum, but this indicator is characteristic of low sensitivity and specificity.Since the reasons for a significant increase in serum alkaline phosphatase levels may be different.For example, elderly patients may be the result of bone mineralization defect or the influence of one of the many drugs, which tend to increase the activity of the hepatic isoenzyme.
Osteocalcin, also called bone gla-protein synthesized by osteoblasts and preferably included into the extracellular matrix of bone.Part of the protein into the bloodstream, where it can be measured by immune methods.The content of osteocalcin in blood is determined, it increased bone fracture due to some endocrine diseases and reduced with a deficiency of vitamin D.
found that under most conditions characterized conjugation resorption and synthesis of bone osteocalcin marker can be considered adequate rate of bone remodeling, and in situations where resorption and synthesis of bone fragmented - a specific marker of bone formation.
Biochemical markers of bone resorption
Determination of calcium on an empty stomach in the morning portion of urine (qualified by creatinine excretion), is the least expensive method of evaluating bone resorption.This method is useful for determining the significantly enhanced resorption insensitive.
Deoksipiridonolin (DPID) is a cross-pyridine bond inherent in mature collagen and did not subjected to further metabolic transformations.It is excreted in the urine in the free form (approximately 40%) in the form of peptides bound (60%).Determination DPID in the urine has a number of advantages:
high specificity for bone turnover;
absence of metabolic transformation to the urinary excretion;
to conduct research without prior dietary restrictions.
value of biochemical markers for the diagnosis and monitoring of osteoporosis therapy
The observations of the main types of therapy groups of drugs, led to the following conclusions:
- raising the level of alkaline phosphatase and osteocalcin serum is often seen in patients with osteoporosis fluorides.The determination of these markers is recommended to monitor the fluoride stimulating effect on bone formation;
- antirezorbtsionnye agents such as bisphosphonates and estrogen, cause osteoporosis, which evolved after menopause, a significant decrease in bone resorption markers concentrations and synthesis of bone until premenopazualnogo level.
Such dynamics of biochemical markers consistent with slowing bone loss, set with osteodensitometry to 9 months.treatment.