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*For medical professionals to read and reference only.
In the process of bone turnover that accompanies human life, biochemical indicators of bone metabolism play an important role in regulating bone.
Bone is a living tissue with metabolism.
Osteoclasts absorb old bone and osteoblasts generate an equal amount of new bone.
Replace to complete bone transformation
.
Biochemical indexes of bone metabolism include: calcium and phosphorus metabolism regulation indexes, bone formation markers, bone resorption markers, hormones and cytokines
.
The bone formation markers and bone resorption markers are collectively referred to as bone turnover markers
.
Biochemical indicators of bone metabolism are derived from bone, cartilage, soft tissue, skin, liver, kidney, small intestine, blood and endocrine glands, etc.
They are enzymes and hormones secreted by osteoblasts or osteoclasts, and collagen metabolism of bone matrix.
product or non-collagen
.
01Bone metabolism regulating hormone parathyroid hormone: It can finely regulate the synthesis and catabolism of bone, and plays an important role in the differentiation, maturation and apoptosis of osteoblasts and osteoclasts
.
Calcitonin: It can reduce the number of osteoclasts, inhibit the activity of osteoclasts, and reduce bone absorption; it can inhibit the absorption of calcium ions in the small intestine and reduce the blood calcium concentration in the body
.
In addition, calcitonin also has a good relieving effect on the symptoms of bone pain caused by many bone metabolic diseases
.
Vitamin D3: is a naturally occurring fat-soluble vitamin that is a steroid hormone
.
There are two sources of vitamin D in the human body: endogenous synthesis and exogenous absorption
.
Endogenous synthesis refers to the photochemical conversion of 7-dehydrocholesterol in epidermal tissue into vitamin D3 under sunlight or ultraviolet irradiation
.
Environmental factors (cigarettes, air particles, inhaled oxidants, etc.
), sunlight, geographic latitude, age factors, skin factors, ethnicity, artificial ultraviolet rays, etc.
all affect the synthesis of vitamin D3
.
Exogenous absorption refers to the supplementation of vitamin D in the human body by ingesting a diet containing vitamin D2 or D3
.
02 Bone formation markers Bone formation markers include bone-specific alkaline phosphatase, osteocalcin, type I procollagen C-terminal propeptide/N-terminal propeptide, and osteoprotegerin
.
The proliferation, differentiation and maturation of bone-specific alkaline phosphatase are closely related to the normal growth and development of bone, reflecting the formation and activity of bone cells
.
Osteocalcin plays an important role in regulating bone calcium metabolism.
Mature osteocalcin is mainly deposited in the interstitial cells of bone tissue and in dentin, and a small part is released into the blood circulation, which can maintain the normal mineralization rate of bone and inhibit cartilage.
rate of mineralization and inhibits the formation of abnormal hydroxyapatite crystals in bone
.
The content of type I procollagen C-terminal propeptide/N-terminal propeptide in serum reflects the ability of osteoblasts to synthesize bone collagen, and its blood content mainly reflects the synthesis rate of type I collagen and the situation of bone turnover, which is the A specific and sensitive indicator of new bone formation
.
Osteoprotegerin, also known as osteoprotegerin, mainly affects bone metabolism, improves bone density, increases trabecular bone mass, reduces the number of osteoclasts, and controls calcium absorption
.
03 Bone resorption markers Bone resorption markers mainly include tartrate-resistant acid phosphatase, type I collagen cross-linked C-terminal peptide, type I collagen cross-linked N-terminal peptide, urinary pyridinoline, and urinary deoxypyridinoline
.
Tartrate-resistant acid phosphatase is mainly derived from osteoclasts
.
As a bone resorption marker, it is a specific and highly sensitive marker of bone resorption
.
The increase of tartrate-resistant acid phosphatase is seen in primary hyperparathyroidism, chronic renal insufficiency, osteitis deformity, tumor bone metastasis, high-transformation osteoporosis, etc.
; the decrease is seen in hypothyroidism
.
Type I collagen cross-linked C-terminal peptide is the most widely used marker of collagen degradation in bone organic matter
.
The level of type I collagen cross-linked C-terminal peptide reflects the bone resorption activity of osteoclasts and is an important biochemical marker of bone resorption.
It mainly reflects the changes of bone metabolism indexes during osteolytic changes.
The degree of increased activity is consistent
.
Serum CTX levels are elevated in patients with osteoporosis, Paget's disease, multiple myeloma, and tumor bone metastases
.
Collagen type I cross-linked N-terminal peptide is a stable final product in the urine after collagen degradation in the liver, and it is a specific and sensitive indicator of bone resorption
.
Osteoporosis, primary hyperparathyroidism, osteitis deformans, hyperthyroidism, tumor bone metastases and multiple myeloma have all been observed
.
Elevated levels of collagen type I cross-linked N-terminal peptides
.
Collagen type I cross-linked N-terminal peptide is considered to be a highly specific indicator for the diagnosis of bone resorption due to its stability and sensitivity in reflecting the characteristics of bone resorption.
The judgment of treatment outcome has important clinical significance
.
References: [1] Expert consensus on clinical application of biochemical indicators of bone metabolism, Chinese Journal of Osteoporosis, Vol.
25, No.
10, October 2019