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1、BiochemicalMarkersofBoneRemodelingTheskeletonconstantlyundergoesaprocessofremodelingthatisessentialforbonehealth.Boneremodelingisacoupledprocessthatbeginswithresorptionofoldbonebyosteoclasts,followedbytheformationofnewbonebyosteoblasts.Beginninginmiddleageorearlier,b
2、onelossoccursbecauseresorptionexceedsformation,afactthatwasidentifiedover50yearsagobyDr.AltonFuller,thefatherofmetabolicbonedisease.Henotedthatpostmenopausalwomenhadelevatedurinarycalciumlevelsanddeducedthatthisreflectsanegativecalciumbalancethatcanresultinosteoporot
3、icfractures.Estrogendeficiencyandmanyotherdiseasesandconditionsaccentuateboneresorption(Watts,1999).Threemajordiagnosticproceduresareavailabletomonitorboneturnoverandevaluatemetabolicbonedisease:boneimagingtechniques,bonebiopsy,andbiochemicalmarkersofboneturnover.Whi
4、lebonedensitymeasurementisanimportantdiagnostictoolinosteoporosis,itisdifficultforthetesttodetectincreasedboneturnoverinitsearlystagesortomonitoracutechanges.Also,bonedensitometrygivesasummatedmeasureofmineralizedbonematrix;itdoesnotdefineabnormaldistributionofbonelo
5、ss.Bonebiopsycandefinethedistributionofbonemassandcananswerquestionsaboutbonemineralizationnotabletobeansweredwithbonedensitometry.However,bonebiopsyisinvasiveand,intheabsenceofmineralizationdefects,itprovidesarelativelystaticglimpseintolongandslowlydevelopingprocess
6、es;itisnotusefulinroutineclinicalmanagementofosteoporosis.Inosteoporosis,netbonelossiscausedbyonlyaslightimbalanceofboneresorptionoverformation,soconventionalmarkers,suchascalciumandPTH,areusuallynormal.Incontrast,boneturnovermarkersaremoresensitivetosubtlechangeandc
7、anbeusedtononinvasivelydetectandmonitorprogressionofmetabolicbonedisease.Laboratoryassessmentofthesemarkershasbeenthefocusofmuchattentioninrecentyears(Ju,1997;Souberbielle,1999).BoneResorptionMarkersBonetissuehasthreecomponents:anorganicmatrix(calledosteoid),bonemine
8、ral,andbonecells.Boneresorptionmarkershaveincludedconstituentsofbonematrixincludingcalciumandcollagendegradationproductssuchashydro
