Ann Lab Med.  2024 Mar;44(2):126-134. 10.3343/alm.2023.0214.

The Use of Bone-Turnover Markers in Asia-Pacific Populations

• Vasikaran S
• Thambiah SC
• Tan RZ
• Loh TP
• AHoRIWG

• KMID: 2553378
• DOI: http://doi.org/10.3343/alm.2023.0214

Abstract

Bone-turnover marker (BTM) measurements in the blood or urine reflect the bone-remodeling rate and may be useful for studying and clinically managing metabolic bone diseases. Substantial evidence supporting the diagnostic use of BTMs has accumulated in recent years, together with the publication of several guidelines. Most clinical trials and observational and reference-interval studies have been performed in the Northern Hemisphere and have mainly involved Caucasian populations. This review focuses on the available data for populations from the Asia-Pacific region and offers guidance for using BTMs as diagnostic biomarkers in these populations. The procollagen I N-terminal propeptide and β-isomerized C-terminal telopeptide of type-I collagen (measured in plasma) are reference BTMs used for investigating osteoporosis in clinical settings. Premenopausal reference intervals (established for use with Asia-Pacific populations) and reference change values and treatment targets (used to monitor osteoporosis treatment) help guide the management of osteoporosis. Measuring BTMs that are not affected by renal failure, such as the bone-specific isoenzyme alkaline phosphatase and tartrate-resistant acid phosphatase 5b, may be advantageous for patients with advanced chronic kidney disease. Further studies of the use of BTMs in individuals with metabolic bone disease, coupled with the harmonization of commercial assays to provide equivalent results, will further enhance their clinical applications.

Keyword

Bisphosphonate; Bone fracture; Bone-turnover marker; Monitoring; Osteoporosis; Reference interval; Renal osteodystrophy; Risk; Standardization; Treatment

Figure

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  Fig. 1 Diagrammatic depiction of relationship between results obtained using an automated intact-PINP assay (IDS iSYS) and an automated total-PINP assay (Roche) in subjects with normal renal function and patients with advanced CKD. X- and Y-axis values are logarithmically spaced. This is a diagrammatic depiction, not real values from a study. Abbreviations: PINP, procollagen type-I N-terminal propeptide; IDS, Immunodiagnostic Systems; CKD, chronic kidney disease.

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