A summary list of bone formation markers is as follows:
- Serum total alkaline phosphatase
- Serum bone–specific alkaline phosphatase
- Serum osteocalcin
- Serum type 1 procollagen (C-terminal/N-terminal): C1NP or P1NP
A summary list of bone resorption markers is as follows:
- Urinary hydroxyproline
- Urinary total pyridinoline (PYD)
- Urinary free deoxypyridinoline (DPD)
- Urinary collagen type 1 cross-linked N-telopeptide (NTX)
- Urinary or serum collagen type 1 cross-linked C-telopeptide (CTX)
- Bone sialoprotein (BSP)
- Tartrate-resistant acid phosphatase 5b
A summary list of bone formation markers is as follows:
- Serum total alkaline phosphatase
- Serum bone–specific alkaline phosphatase
- Serum osteocalcin
- Serum type 1 procollagen (C-terminal/N-terminal): C1NP or P1NP
A summary list of bone resorption markers is as follows:
- Urinary hydroxyproline
- Urinary total pyridinoline (PYD)
- Urinary free deoxypyridinoline (DPD)
- Urinary collagen type 1 cross-linked N-telopeptide (NTX)
- Urinary or serum collagen type 1 cross-linked C-telopeptide (CTX)
- Bone sialoprotein (BSP)
- Tartrate-resistant acid phosphatase 5b
Kindly go through the following RG links.
Article Bone biomarker for the clinical assessment of osteoporosis: ...
Article Bone turnover markers: Emerging tool in the management of osteoporosis
Article The clinical utility of bone marker measurements in osteoporosis
The two markers that are used clinically are N-terminal propeptide of type I procollagen (P1NP) and C-telopeptide of type I collagen (CTX), the first being a measure of the degree of bone formation and the second of resorption. In patients with osteoporosis, other tests such as renal function, serum calcium and phosphate, alkaline phosphatase, etc... should be added for the overall assessment of the patient, but these determinations are not strict bone markers. In renal patients, tartrate-resistant acid phosphatase 5b is useful, since the above are dependent on glomerular filtration.
They are subject to significant variability: food reduces CTX (fasting is necessary for 12 hours before extraction) and recent fractures increase both. They are not useful for the diagnosis of osteoporosis or improve the prediction of fracture risk. They are used to control the therapeutic response in patients with osteoporosis, to suspect possible secondary causes and also to check compliance. Another possible indication is to improve T2T strategies and also, in control of "therapeutic hollidays" of bisphosphonates.
Bone markers or biochemical markers of bone turnover are divided into 2 categories:
1. Markers for bone resorption &
2. Markers for bone formation.
Bone alkaline phosphatase & Procollagen type I N propeptide (PINP) are considered as markers for bone formation; while carboxy-terminal cross-linking telopeptide of type I collagen (CTX), amino-terminal cross linking telopeptide of type I collagen (NTX) & deoxypyridoline (DPD) are for bone resorption.
Blood or urine level of these markers can be used as osteoporosis marker.
Types of marker include the following: Bone resorption - Urine NTX or serum CTX or urine CTX. Bone formation - Bone-specific alkaline phosphatase or osteocalcin (Use 1 marker or 1 resorption and 1 formation marker.)
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