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Bone Markers

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Also known as: Bone Resorption Markers; Bone Formation Markers; Bone Turnover Tests; N-telopeptide; NTx; C-telopeptide; CTx; Deoxypyridinoline; DPD; Pyridinium Crosslinks; Tartrate-resistant Acid Phosphatase; TRAP; Bone-specific Alkaline Phosphatase; Osteocalcin; P1NP; Procollagen Type 1 N-Terminal Propeptide
Formal name: Biochemical Markers of Bone Remodeling
Related tests: Calcium, Phosphorus, Vitamin D, PTH, ALP

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Talwar, S. and Aloia, J. (Updated 2012 January 3). Bone Markers in Osteoporosis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/128567-overview through http://emedicine.medscape.com. Accessed February 2013.

Staros, E. (Updated 2012 September 7). N-Terminal Telopeptide. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2093977-overview#showall through http://emedicine.medscape.com. Accessed February 2013.

Medscape Editorial Staff (Updated 2012 October 1). C-Terminal Telopeptide. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2093999-overview#showall through http://emedicine.medscape.com. Accessed February 2013.

Jacobs-Kosmin, D. and Shanmugam, S. (Updated 2012 December 10). Osteoporosis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/330598-overview through http://emedicine.medscape.com. Accessed February 2013.

Meikle, A. W. (Update 2013 January). Osteoporosis. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/Osteoporosis.html#tabs=0 through http://www.arupconsult.com. Accessed February 2013.

Bolster, M. (Revised 2012 December). Osteoporosis. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed February 2013.

Singer, F. and Eyre, D. (2008). Using biochemical markers of bone turnover in clinical practice. [On-line information]. Cleveland Clinic Journal of Medicine October 2008 vol. 75 10 739-750. Available online at http://www.ccjm.org/content/75/10/739.full through http://www.ccjm.org. Accessed February 2013.

(© 2013). NOF's Newly Revised 2013 Clinician's Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation [On-line information]. Available online at http://nof.org/hcp/practice/practice-and-clinical-guidelines/clinicians-guide through http://nof.org. Accessed March 2013.

Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 522-523.

McPherson, R. and Pincus, M. (© 2011). Henry's Clinical Diagnosis and Management by Laboratory Methods 22nd Edition: Elsevier Saunders, Philadelphia, PA. Pp 205-206.

Srivastava A, et.al. Clinical Use of Serum and Urine Bone Markers in the Management of Osteoporosis. Medscape news, Curr Med Res Opin. 2005;21(7):1015-1026. Available online at http://medscape.com/viewarticle/508542_1 through http://medscape.com. Accessed March 3013.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. 4th edition, St. Louis: Elsevier Saunders; 2006, Pp 1932-1943.

Vasikarin S, et. al. International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine Position on bone marker standards in osteoporosis. Clin Chem Lab Med 2011;49(8):1271–1274.

Sources Used in Previous Reviews

Interview with Laurence M. Demers, PhD. Distinguished Professor of Pathology and Medicine, The Pennsylvania State University College of Medicine, The M. S. Hershey Medical Center, Hershey, PA. Additionally, conducted article review March 2009.

Srivastava, A. (2005 July 22). Clinical Use of Serum and Urine Bone Markers in the Management of Osteoporosis. Medscape from Curr Med Res Opin 2005;21(7): 1015-1026 [On-line journal]. Available online at http://www.medscape.com/viewarticle/508542_print through http://www.medscape.com.

Vesper, H. (2005 August 10). Analytical and Preanalytical Issues in Measurement of Biochemical Bone Markers. Medscape from Lab Med. 2005;36(7):424-429 [On-line journal]. Available online at http://www.medscape.com/viewarticle/509097 through http://www.medscape.com.

(© 2005). Bone Turnover, Biochemical Markers. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_a125.jsp#1145643 through http://www.aruplab.com.

(2005 June, Revised). Osteoporosis Overview. NIAMS [On-line information]. Available online at http://www.niams.nih.gov/bone/hi/overview.htm through http://www.niams.nih.gov.

Bone Disease in Chronic Kidney Failure (July 2006- Online information). National Kidney Foundation. Available online at http://www.kidney.org/atoz/atozItem.cfm?id=49 through http://www.kidney.org.

Hyperparathyroidism: What It Is and How It's Treated (July 2006-Online information). American Association of Family Physicians. Available online at http://familydoctor.org/251.xml through http://familydoctor.org.

Rickets (July 2006-Online information). MedlinePlus, NIH. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000344.htm.

Coleman, Robert et al. Predictive Value of Bone Resorption and Formation Markers in Cancer Patients With Bone Metastases Receiving the Bisphosphonate Zoledronic Acid. Journal of Clinical Oncology, Vol 23, No 22 (August 1), 2005; Pp. 4925-4935.

Rosen, C.J. et al. The Predictive Value of Biochemical Markers of Bone Turnover for Bone Mineral Density in Early Postmenopausal Women Treated with Hormone Replacement or Calcium Supplementation. Journal of Clinical Endocrinology & Metabolism Vol. 82, No. 6 1904-1910, 1997.

N.H Bjarnasona, C Christiansena. Early response in biochemical markers predicts long-term response in bone mass during hormone replacement therapy in early postmenopausal women. Bone. Vol 26, Issue 6, Pp 561-569 (2000).

Lein M et al. Bone Turnover Markers As Predictive Tools For Skeletal Complications In Men With Metastatic Prostate Cancer Treated With Zoledronic Acid Prostate. Prostate Feb. 2009.

Shidara K et al. Serum levels of TRAP5b, a new bone resorption marker unaffected by renal dysfunction, as a useful marker of cortical bone loss in hemodialysis patients. Calcif Tissue Int. 2008 Apr;82(4):278-87.

Centers for Disease Control and Prevention. Improving the Clinical Use of Biochemical Bone Marker in Metabolic Bone Diseases. Available online at http://www.cdc.gov/NCEH/DLS/osteoporosis.htm through http://www.cdc.gov. Accessed March 2009.

Hubert W. Vesper, PhD. Analytical and Preanalytical Issues in Measurement of Biochemical Bone Markers. Medscape Today from Lab Med. 2005;36(7):424-429. Available online at http://www.medscape.com/viewarticle/509097_2 through http://www.medscape.com. Accessed March 2009.

ARUP Consult. Osteoporosis. Available online at http://www.arupconsult.com/Topics/EndocrineDz/Osteoporosis.html# through http://www.arupconsult.com. Accessed March 2009.

Vesper, H. (2005 August 10). Analytical and Preanalytical Issues in Measurement of Biochemical Bone Markers. Medscape from Laboratory Medicine [On-line information]. Available online at http://www.medscape.com/viewarticle/509097 through http://www.medscape.com.

Srivastava, A. (2005 July 22). Clinical Use of Serum and Urine Bone Markers in the Management of Osteoporosis. Medscape Current Medical Research and Opinion [On-line information]. Available online at http://www.medscape.com/viewarticle/508542 through http://www.medscape.com.

(2006 July). Procollagen Type 1 N-Terminal Propeptide. ARUP Technical Bulletin [On-line information]. PDF available for download through http://www.aruplab.com.

Cundy, T. et. al. (2007 April 13). Bone Formation Markers in Adults with Mild Osteogenesis Imperfecta. Clinical Chemistry 2007; 53:1109-1114. [On-line abstract]. Available online at http://www.clinchem.org/cgi/content/abstract/53/6/1109 through http://www.clinchem.org.

Garnero, P. et al. Evaluation of a Fully Automated Serum Assay for Total N-Terminal Propeptide of Type I Collagen in Postmenopausal Osteoporosis. Clinical Chemistry 2008; 54:1, Pp. 188-196.