骨代谢生化指标临床应用专家共识(2020)

骨代谢生化指标包括钙磷代谢调节指标、骨形成标志物、骨吸收标志物、激素与细胞因子。骨代谢生化指标分别来源于骨、软骨、软组织、皮肤、肝、肾、小肠、血液及内分泌腺体等,是由成骨细胞或破骨细胞分泌的酶和激素,以及骨基质的胶原蛋白或非胶原蛋白代谢产物。骨代谢生化指标可及时反映骨转换状态,灵敏度高、特异性强,用于骨质疏松诊断分型、预测骨折风险、抗骨质疏松治疗疗效评价,以及代谢性骨病的诊断与鉴别诊断。并且在骨质疏松流行病学、发病机制、骨质疏松药物的研究方面具有重要的临床意义。本文对《骨代谢生化指标临床应用专家共识(2019)》进行了修订,共有41处修改,保留了经典文献,删减了部分内容,增加了近三年的文献,收集整理了骨代谢指标实验检测参考范围。     

中国老年学学会骨质疏松委员会骨代谢生化指标临床应用专家共识

骨代谢生化指标包括：钙磷代谢调节指标、骨吸收标志物、骨形成标志物。骨代谢生化指标分别来源于骨、软骨、软组织、皮肤、肝、肾、小肠、血液及内分泌腺体等,是由成骨细胞或破骨细胞分泌的酶和激素,以及骨基质的胶原蛋白代谢产物或非胶原蛋白。骨代谢生化指标可及时反映骨转换状态,灵敏度高、特异性强,用于骨质疏松诊断分型、预测骨折风险、抗骨质疏松治疗疗效评价,以及代谢性骨病的鉴别诊断。并且在骨质疏松发病机制、骨质疏松药物的研究及流行病学研究方面具有重要临床意义。随着骨代谢生化指标检测技术逐渐成熟,临床应用日趋广泛,但不同来源的标本、不同方法、不同设备、不同试剂、人的不同年龄段、不同种族和不同性别等,检测结果存在差异。至今,骨代谢生化指标测定国内外尚无统一检测标准;为此,将骨代谢生化指标的生物学作用及临床意义、技术应用与质量控制,分别整理、凝炼成一篇为各位同仁可读、可用、可参考的文字材料。期待通过＂共识＂为推动临床骨代谢生化指标检测技术的提高,规范检测流程,建立科学的参考范围,使骨代谢生化指标在骨质疏松规范诊断、规范治疗、抗骨质疏松药物疗效评价及科研工作中发挥重要作用。     

骨代谢生化指标实验推荐方案

骨代谢生化指标包括钙磷代谢调节指标、骨形成标志物、骨吸收标志物、激素与细胞因子。其中骨形成标志物与骨吸收标志物合称为骨转换标志物。目前临床应用酶联免疫吸附测定、化学发光免疫测定、电化学发光免疫分析、放射免疫分析、免疫放射分析、高效液相色谱等方法检测血、尿中骨代谢生化指标水平,了解骨组织新陈代谢的情况,用于评价骨代谢状态、骨质疏松诊断分型、预测骨折风险、监测骨质疏松治疗疗效和代谢性骨病的鉴别诊断。本文复习了近年来中英文文献,总结了骨代谢生化指标的检测方法及原理,提出了骨代谢生化指标推荐方案。期待为骨代谢生化指标的推广和研究发挥积极作用。     

骨重建中的骨代谢指标

骨重建是破骨细胞和成骨细胞共同完成的旧骨退化,等量新骨取代的骨组织更新过程,在骨重建过程中,许多激素和细胞、体液因子以及细胞代谢产物影响骨的重建.目前国内外通过生物化学检测技术获得的骨代谢指标分为骨代谢调节激素、细胞与体液因子、骨吸收、骨形成标志物.笔者将影响骨重建生物化学指标的生理作用、临床意义进行综述.骨代谢指标虽不能作为骨质疏松诊断的金标准,但已广泛应用于临床,评价骨代谢状态、骨质疏松诊断分型、预测骨折风险、观察药物治疗的疗效,以及代谢性骨病的鉴别诊断.并且在抗骨质疏松药物的研究及流行病学研究方面具有重要应用价值.     

骨转换生化标志物的研究进展

骨转换生化标志物具有灵敏性高、特异性强、稳定性好等优点,较骨密度更早反映出骨量变化,联合检测骨转换生化标志物,对评估骨形成和骨吸收的平衡状态、骨代谢疾病的鉴别诊断、抗骨质疏松疗效等方面有重要意义。骨转换生化标志物在骨质疏松症的诊断及骨代谢相关疾病的鉴别诊断以及抗骨质疏松治疗疗效判断方面均有重要意义,目前BALP、P1NP、TRAP、CTX作为相对研究较广泛的骨转化标志物已被应用于临床,一些较新的骨转换标志物(如OPG、LP、Cat K等)是否能作为预测骨折风险、监测治疗疗效的指标仍需临床医师进一步研究,以使其发挥最大的价值。本文对骨形成生化标志物、骨吸收生化标志物的研究进展及其在临床中的应用进行了简单综述。     

骨代谢标志物在乳腺癌骨质疏松中的评估价值

目的探究骨代谢标志物在乳腺癌骨质疏松中的诊断价值。方法选取2014年6月至2017年6月在我院住院接受治疗的182例乳腺癌骨质疏松患者为本次研究的研究对象,对本研究对象的骨代谢标志物BALP以及uNTx水平进行检测,统计并对比治疗前后乳腺癌骨质疏松患者骨代谢标志物的变化情况,采用单因素分析方法及多元线性回归分析方法分析影响乳腺癌骨质疏松患者骨代谢标志物水平的因素。结果乳腺癌骨质疏松患者骨代谢标志物BALP以及uNTx水平明显高于正常水平(P0.05),治疗后两者水平均明显低于治疗前(P0.05);单因素分析显示,骨代谢标志物BALP以及uNTx水平与患者骨转移数目呈正相关(P0.05),与骨痛程度无明显联系(P0.05);多元线性回归分析,骨代谢标记物和骨转移数目是影响患者近期疗效的相关因素。结论骨代谢标志物水平与骨质疏松有着密切联系,可作为乳腺癌骨质疏松的理想诊断指标,且该指标相对于影像学检查反应敏感性更强。     

骨代谢生化指标临床应用专家共识(2023修订版)

骨代谢生化指标的临床应用，为骨质疏松的诊断、鉴别诊断、预测骨折风险及抗骨质疏松治疗疗效评价提供了分子生物学依据，并在骨质疏松流行病学研究、发病机制、骨质疏松药物开发研究方面具有重要意义。由于骨代谢生化指标检测特异性强、灵敏度高，其应用日趋广泛。该文检索了大量中外文献，编审了《骨代谢生化指标临床应用专家共识》(2023修订版),对骨代谢生化指标的分类、骨代谢生化指标的方法学以及生物学意义、骨代谢指标的检测变异等进行了论述。     

骨代谢标志物在骨质疏松症中医药诊疗中的应用研究进展

骨质疏松症是一种以骨代谢异常,骨微结构破坏,导致脆性骨折危险性增高为特征的慢性全身性骨病,对人体的健康有着重要的影响。传统中医学对骨质疏松症有着深刻的认识,骨质疏松属于中医"骨痿"、"骨痹"的范畴,其发病多以肾虚为本,血瘀为标,中医药在预防、治疗治骨质疏松症方面的的作用举足轻重。骨代谢生化标志物是从血液、尿液中可检测出的骨代谢生化产物或相关激素,可反映人体骨代谢状态,是协助代谢性骨病的诊断、鉴别诊断、治疗以及疗效评价的重要指标,目前已广泛应用于骨质疏松症的中医体质辨识、证候的诊断及药物疗效评价等方面。本文通过文献综述的方式,对近些年来骨代谢标志物在骨质疏松症中医诊疗中的应用研究进行归纳,以期为今后的研究提供参考。     

合理使用骨质疏松症诊疗的骨代谢标志物指南(2004年版）

我国骨质疏松医学事业近年来发展很快,但骨质疏松生化标志物的诊断发展滞后,我们看到日本骨质疏松杂志,2004,12(2)发表的"合理使用骨质疏松症诊疗的骨代谢标志物指南"一文很好,现全文译成中文供大家参考,以推动我国骨质疏松生化诊断工作的开展。     

生化标志物在骨质疏松诊断、骨折预测和疗效观察中的应用

近20年来,骨代谢的生化标志物方面的研究取得了很大进展,许多新的更敏感的指标被发现,并被应用于临床研究和作为治疗效果的观察指标,近期日本学者还提出了“骨转化生化标志物应用于骨质疏松的指南2001”(后文简称“2001指南”)[1]。多数研究集中于这些指标在绝经后骨质疏松方面的应用,但在个体化临床应用方面还未明确阐明。     

Guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis (2012 edition)

Recently the clinical application of bone metabolic markers has achieved significant progress and the measurements of these indices give us a better understanding of the pathogenesis of osteoporosis. Bone metabolic markers were adapted to select drug treatment for osteoporosis and to evaluate drug efficacy. Therefore, the proper application and assessment of bone metabolic markers in clinical practice is very important. To achieve these aims, the committee on the guidelines for the use of biochemical markers of bone turnover in osteoporosis authorized by the Japan Osteoporosis Society has summarized recent progress in bone markers and proposed the proper utilization of bone markers. Although the use of bone metabolic markers now has an important role in the daily management of osteoporosis, their use in Japan is still insufficient because of insurance coverage limitations. Since the Japan Osteoporosis Society first created the 2001 guidelines, new bone metabolic markers have been introduced into clinical practice. The availability of new osteoporosis treatments that promote bone formation has changed the clinical application of bone metabolic markers in current practice. Therefore, revisions to the current clinical practice are needed which led to the proposal to create these new 2012 guidelines.     

跆拳道对女大学生骨结构特征变化的研究

目的 了解跆拳道训练对处于青春期及青春后期女大学生骨代谢的影响,为高校女大学生健身锻炼、改善与提高骨代谢及预防骨质疏松提供一定的理论依据。方法 运用追踪调査、文献资料、数理统计及逻辑分析等研究方法对山东科技大学劲松跆拳道俱乐部女大学生训练期间的骨结构特征随运动强度等因素变化的规律及特点进行研究,研究跆拳道运动训练对处于青春期及青春后期女大学生骨代谢的影响与骨量、骨矿生化成分及骨形成生化标志物的影响,并分析骨密度、骨形态结构变化的影响因素。结果 跆拳道训练作为对机体、肌肉与骨骼高强冲击性的搏击运动形式,可以提高肌肉力量从而对骨骼产生积极的影响。结论 高抗阻、有氧耐力及振动的综合性跆拳道运动能够改善女大学生的骨代谢及提高骨密度与骨量,为运动健身指导及预防骨质疏松方面提供一定的理论帮助。     

肌肉、骨骼与骨质疏松专家共识

骨质疏松症已成为全球性的公共健康问题和前沿研究难题。老年人骨骼肌肉系统的衰退会造成肌肉萎缩、骨质减少,进而引起肌力减退、运动能力、平衡能力下降、步行缓慢、骨脆性增大、易骨折,最终导致老年人生活质量下降。如何从肌肉、骨骼方面研究其与骨质疏松的关系非常迫切和重要。为此,中国老年学学会骨质疏松委员会成立了肌肉、骨骼与骨质疏松学科组,组织专家编写《肌肉、骨骼与骨质疏松专家共识》,为骨质疏松症的临床诊疗和科学研究提供参考。共识认为:骨质疏松与肌肉、骨骼密切相关。骨质疏松症和肌少症存在着很多共同的风险因素。肌骨代谢生化指标可反映肌骨代谢状态,对代谢性肌肉骨骼疾病的诊断和疗效评价有指导作用。推荐使用DXA测量肌肉质量和骨密度。肌力和平衡能力评定有助于判断跌倒风险。肌肉、骨骼存在潜在的药物作用共同靶点。肌肉骨骼运动可以增加峰值骨量,调节骨代谢信号通路,促进骨形成。骨质疏松人群应注重个体化运动锻炼。中医学认为肌肉、骨骼与脾、肝、肾关系密切,骨质疏松症的病位主要在肾、脾、经络,主要与肾虚、脾虚和血瘀有关,强调骨筋肉并重,动静结合,治疗原则宜补肾、健脾、活血。     

γ-Tocotrienol protects against ovariectomy-induced bone loss via mevalonate pathway as HMG-CoA reductase inhibitor

γ-Tocotrienol (GT3), an analogue of vitamin E, has gained increasing scientific interest recently as it provides significant health benefits. GT3 exerts its biological effects not only by virtue of antioxidant properties but also by inhibiting hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase. Studies have reported that the mevalonate pathway is relevant for bone metabolism and HMG-CoA reductase inhibitors can increase bone mass and are useful in osteoporosis therapy. However, whether it is involved in the bone anabolic activity of GT3 is not clear. This study was conducted to investigate the ability of GT3 to protect against ovariectomy-induced bone loss, as well as the correlation between the protections and mevalonate pathway. Results showed that mice supplemented with 100 mg/kg emulsified GT3 via subcutaneous injection once per month for three months were significantly protected from ovariectomy-induced bone loss as evaluated by various bone structural parameters, bone metabolic gene expression levels and serum levels of biochemical markers for bone resorption and bone formation. Importantly, the effect of GT3 on preventing against ovariectomy-induced bone loss could be reversed by daily supplementation with mevalonate, indicating that GT3 may via an HMG-CoA reductase-dependent mechanism to protect against ovariectomy-induced bone loss. Our results suggest that GT3 is suitable as dietary supplement and has potential as an alternative drug to treat or prevent osteoporosis.     

Laboratory diagnosis of osteoporosis

Bone is biologically a highly active tissue whose cells are embedded in a complex network of systemically acting hormones and local mediators. The mechanisms of action involved are as yet only partially understood. With the increase in life expectancy and the resultant change of the population's age structure, diseases of the musculoskeletal system and bones have increased in importance. Thus, research is directed to a greater extent toward bone metabolism and the most frequent bone disease, osteoporosis. Until a few decades ago, the diagnosis of a bone disease was based principally on clinical and radiological methods. Laboratory methods only included the measurement of total alkaline phosphatase activity and calcium and phosphate balance. The development and introduction of new biochemical markers of bone metabolism in recent years led to a considerable increase in available laboratory methods. To evaluate the activity of osteoblastic synthesis, alkaline phosphatase and other bone-forming markers with higher tissue specificity such as bone alkaline phosphatase, osteocalcin, and several collagen propeptides are used. Bone degradation (calcium and hydroxyproline were the only markers until several years ago) can now be detected quickly and reliably with many new serological and urinary markers. Pyridinium derivatives and telopeptides as products of the metabolic activity of osteoclasts have been proved efficacious in diagnosis and therapy control.     

The Relevance of Osteoclastic and Osteoblastic Activity Markers Follow-Up in Patients on Antiresorptive Osteoporosis Treatment

In general, markers of bone formation and markers of bone resorption are changing synergistically, so the monitoring of any osteoclastic and any osteoblastic marker should reflect the rate of bone transformation. The aim of the study is to monitor the bone metabolism markers in postmenopausal women with osteoporosis and osteopenia along with the variations caused by the effects of bisphosphonate therapy. The study involved 55 women of average age of 57.95 years, with osteopenia or osteoporosis. The patients with osteoporosis were treated with bisphosphonates (75?mg once a week); the laboratory tests were performed before the treatment and 6 months later. Patients with osteopenia were evaluated at the first assessment and 6 months later. The tests included bone densitometry, dual-energy X-ray absorptiometry, osteocalcin, alkaline phosphatase, collagen 1 N-terminal pro-peptide (P1NP), and beta C telopeptide of type I collagen (CTX). The mean T-score was ?2.80?±?0.63 before therapy and ?2.64?±?0.45 6 months later (p?<?0.001). Women with osteoporosis had elevated levels of osteocalcin and P1NP at the first assessment, whereas the alkaline phosphatase level did not change with the treatment. After the introduction of antiresorptive therapy, the levels of osteocalcin and P1NP significantly decreased (p?<?0.001). In the group with osteopenia, the biochemical markers activity were increased in both assessments. In patients with osteoporosis, Beta-CTX was increased in the first evaluation, and decreased after treatment (p = 0.001). The results indicate that the assessment of biochemical markers of bone metabolism show excellent results in the assessment of prognosis, monitoring the course and the response to various treatment regimens of osteoporosis and evince strong correlation with standard densitometry and dual-energy X-ray absorptiometry procedures. P1NP and CTX show better diagnostic applicability compared with osteocalcin and alkaline phosphatase. The analysis of the activity of biochemical markers may obtain early information on the therapeutic response, before definitive assessment by bone density measurements.