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©2013 UpToDate ® Print Email Bone turnover markers Formation Assay Circadian rhythm LSC Comments OC S* Y 21 percent Lack of standardization, rapidly degraded in serum, requires collection on ice BALP S* N 28 percent Cross-reactivity with liver isoform (15 to 20 percent) P1NP/P1CP S* Y 21 percent/24 percent Resorption NTX U*,S Y 35 percent (S), 70 percent (U) CTX U,S* Y 30 percent (S), 80 percent (U) D-PYR U Y 26 percent PYD U* Y 36 percent HYP U Reflects bone resorption and dietary intake TRACP5b S Y 17 percent OC: Osteocalcin; BALP: Bone-specific alkaline phosphatase; P1NP: N-terminal propeptide of type 1 procollagen; P1CP: C-terminal propeptide of type 1 procollagen; NTX: cross-linked N-telopeptide of type 1 collagen; CTX: cross-linked C- telopeptide of type 1 collagen; D-PYR: Free deoxypyridinoline; PYD: Free pyridinoline; HYP: Hydroxyproline; TRACP5b: isoform 5b of tartrate resistant acid phosphatase. S: serum, collection of serum should be performed in the morning after an overnight fast; U: urinary excretion, collection of urine should be performed in the morning (usually second AM void, fasting); LSC: Least significant change; Circadian rhythm: higher in the early morning. * Automated technology for measurement is available.

OC: Osteocalcin; BALP: Bone-specific alkaline phosphatase; P1NP: N-terminal propeptide of type 1 procollagen; P1CP: C-terminal propeptide of type 1 procollagen; NTX: cross-linked N-telopeptide of type 1 collagen; CTX: cross-linked C- telopeptide of type 1 collagen; D-PYR: Free deoxypyridinoline; PYD: Free pyridinoline; HYP: Hydroxyproline; TRACP5b: isoform 5b of tartrate resistant acid phosphatase. S: serum, collection of serum should be performed in the morning after an overnight fast; U: urinary excretion, collection of urine should be performed in the morning (usually second AM void, fasting); LSC: Least significant change; Circadian rhythm: higher in the early morning. * Automated technology for measurement is available. Data from: Bergmann P, Body JJ, Boonen S, et al. Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club. Int J Clin Pract 2009; 63:19. Scariano JK, Garry PJ, Montoya GD, et al. Critical differences in the serial measurement of three biochemical markers of bone turnover in the sera of pre-and postmenopausal women. Clin Biochem 2001; 34:639. Baim S, Miller PD. Assessing the clinical utility of serum CTX in postmenopausal osteoporosis and its use in predicting risk of osteonecrosis of the jaw. J Bone Miner Res 2009; 24:561. Hannon R, Blumsohn A, Naylor K, Eastell R. Response of biochemical markers of bone turnover to hormone replacement therapy:Impact of biological variability. J Bone Miner Res 1998; 13:1124. Rosen HN, Parker RA, Greenspan SL, et al. Evaluation of ability of biochemical markers of bone turnover to predict a response to increased doses of HRT. Calcified Tissue International 2004; 74:415. Miller PD, Baran DT, Bilezikian JP, et al. Practical applications of biochemical markers of bone turnover:Consensus of an expert panel. J Clin Denistom 1999; 2:323.