骨代谢指标物在骨质疏松症诊疗中的应用进展_West China Medical Journal

Authors：

 朱传美

四川大学华西医院门诊部（成都 610041）;

Corresponding author：

Keywords：

骨代谢指标物; 骨质疏松症; 骨密度; 骨强度

DOI：

10.7507/1002-0179.20150450

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骨质疏松症（OP）属于全球重要健康问题，主要以骨量减低、骨微结构损坏、以致骨脆性增加，骨折风险增高为特点。依照世界卫生组织标准，通过双能X线检测骨密度仍是目前诊断OP及判断其严重程度的金标准。然而，由于骨密度并非影响骨强度的唯一因素，且具有结果相对恒定，对干预疗效的反应不够灵敏等不足之处，体现骨重建水平的骨代谢标志物则在一定程度上起到了与骨密度相辅相成的作用，对OP的辅助诊断、疗效监测以及治疗方案的选择方面起到了良好的作用。不仅如此，由于骨密度不适宜频繁检测而缺乏对患者给予相应的正向疗效反馈，导致OP患者依从性较低。而定期检查骨代谢标志物，可行性好，通过其动态变化情况可提高依从性，使患者坚持治疗。现就临床上较为常用的几种骨代谢指标作一综述。

Citation： 朱传美. 骨代谢指标物在骨质疏松症诊疗中的应用进展. West China Medical Journal, 2015, 30(8): 1567-1570. doi: 10.7507/1002-0179.20150450 Copy

1.	Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis[J]. Osteoporos Int, 1999, 10(4):259-264.
2.	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊治指南(2011年)[J]. 柳州医学, 2012, 04(3):188-199.
3.	李宁华, 朱汉民, 区品中, 等. 中国部分地区中老年人群原发性骨质疏松症患病率研究[J]. 中华骨科杂志, 2001, 21(5):18-21.
4.	Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis:synopsis of a WHO report. WHO Study Group[J]. Osteoporos Int, 1994, 4(6):368-381.
5.	肖恩, 孟萍. 骨质疏松骨代谢生化指标的研究进展[J]. 中国骨质疏松杂志, 2008, 14(3):212-216, 147.
6.	张红, 罗湘杭, 谢辉, 等. 基质金属蛋白酶-1、-2与女性年龄、骨转换生化指标及骨密度的关系[J]. 中华内科杂志, 2006, 45(4):306-309.
7.	张新菊, 李融. 骨代谢标志物相关研究进展[J]. 山东医药, 2014(16):93-95.
8.	Pedersen BJ, Schlemmer A, Rosenquist C, et al. Circadian rhythm in typeⅠcollagen formation in postmenopausal women with and without osteopenia[J]. Osteoporos Int, 1995, 5(6):472-477.
9.	Hernández MV, Guañabens N, Alvarez L, et al. Immunocytochemical evidence on the effects of glucocorticoids on typeⅠcollagen synthesis in human osteoblastic cells[J]. Calcif Tissue Int, 2004, 74(3):284-293.
10.	DeFranco DJ, Glowacki J, Cox KA, et al. Normal bone particles are preferentially resorbed in the presence of osteocalcin-deficient bone particles in vivo[J]. Calcif Tissue Int, 1991, 49(1):43-50.
11.	王琳, 牛爱军. 骨代谢标志物在多发性骨髓瘤诊治中的应用现状[J]. 实用医药杂志, 2011, 28(9):844-846.
12.	阙文君, 冯正平. 骨转换生化标志物的研究进展[J]. 中国骨质疏松杂志, 2014(5):575-579.
13.	Löfman O, Magnusson P, Toss G, et al. Common biochemical markers of bone turnover predict future bone loss:a 5-year follow-up study[J]. Clin Chim Acta, 2005, 356(1/2):67-75.
14.	杨国君, 吕龙. 骨转换标志物与骨质疏松症的研究进展[J]. 内蒙古医科大学学报, 2012, 34(增刊1):105-110.
15.	O'brien CA. Control of RANKL gene expression[J]. Bone, 2010, 46(4):911-919.
16.	Jabbar S, Drury J, Fordham JN, et al. Osteoprotegerin, RANKL and bone turnover in postmenopausal osteoporosis[J]. J Clin Pathol, 2011, 64(4):354-357.
17.	Chen YH, Wu YW, Yang WS, et al. Relationship between bone mineral density and serum osteoprotegerin in patients with chronic heart failure[J]. PLoS One, 2012, 7(8):e44242.
18.	Qin YJ, Zhang ZL, Zhang H, et al. Age-related changes of serum tartrate-resistant acid phosphatase 5b and the relationship with bone mineral density in Chinese women[J]. Acta Pharmacol Sin, 2008, 29(12):1493-1498.
19.	王鸿度, 陈庄, 扶世杰, 等. 骨转换生化标志物昼夜节律的研究进展[J]. 中国骨质疏松杂志, 2009, 15(12):944-948, 943.
20.	何娟文, 肖争. 骨代谢标志物研究进展[J]. 中外健康文摘, 2013(48):146-147.
21.	贾成瑶, 李萍. 尿吡啶啉和脱氧吡啶啉是骨吸收特异性生化标志物[J]. 中国临床康复, 2002, 6(15):2256-2257.
22.	Halleen JM. Tartrate-resistant acid phosphatase 5B is a specific and sensitive marker of bone resorption[J]. Anticancer Res, 2003, 23(2A):1027-1029.
23.	宋志荣, 张淑琴, 阚耀东. 尿脱氧吡啶啉测定和骨密度检测对诊断骨质疏松症的对比观察[J]. 上海医学检验杂志, 2002, 17(2):105-106.
24.	Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption[J]. Eur J Endocrinol, 1999, 140(4):332-337.
25.	Bauer D, Krege J, Lane N, et al. National bone health alliance bone turnover marker project:current practices and the need for US harmonization, standardization, and common reference ranges[J]. Osteoporos Int, 2012, 23(10):2425-2433.
26.	Vasikaran S, Eastell R, Bruyère O, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment:a need for international reference standards[J]. Osteoporos Int, 2011, 22(2):391-420.
27.	李萌, 李玉坤. 骨转换标志物及其临床应用[J]. 临床荟萃, 2014, 29(1):104-108.
28.	Kindblom JM, Ohlsson C, Ljunggren O, et al. Plasma osteocalcin is inversely related to fat mass and plasma glucose in elderly Swedish men[J]. J Bone Miner Res, 2009, 24(5):785-791.
29.	Eastell R, Vrijens B, Cahall DL, et al. Bone turnover markers and bone mineral density response with risedronate therapy:relationship with fracture risk and patient adherence[J]. J Bone Miner Res, 2011, 26(7):1662-1669.
30.	Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women:the EPIDOS Prospective Study[J]. J Bone Miner Res, 1996, 11(10):1531-1538.
31.	Manavalan JS, Cremers S, Dempster DW, et al. Circulating osteogenic precursor cells in type 2 diabetes mellitus[J]. J Clin Endocrinol Metab, 2012, 97(9):3240-3250.
32.	张金山, 罗良平. 绝经前期妇女血清PINP、ICTP和25-OH-VitD3水平的变化及其与BMD的相关性分析[J]. 放射免疫学杂志, 2010, 23(6):603-605.

1. Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis[J]. Osteoporos Int, 1999, 10(4):259-264.
2. 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊治指南(2011年)[J]. 柳州医学, 2012, 04(3):188-199.
3. 李宁华, 朱汉民, 区品中, 等. 中国部分地区中老年人群原发性骨质疏松症患病率研究[J]. 中华骨科杂志, 2001, 21(5):18-21.
4. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis:synopsis of a WHO report. WHO Study Group[J]. Osteoporos Int, 1994, 4(6):368-381.
5. 肖恩, 孟萍. 骨质疏松骨代谢生化指标的研究进展[J]. 中国骨质疏松杂志, 2008, 14(3):212-216, 147.
6. 张红, 罗湘杭, 谢辉, 等. 基质金属蛋白酶-1、-2与女性年龄、骨转换生化指标及骨密度的关系[J]. 中华内科杂志, 2006, 45(4):306-309.
7. 张新菊, 李融. 骨代谢标志物相关研究进展[J]. 山东医药, 2014(16):93-95.
8. Pedersen BJ, Schlemmer A, Rosenquist C, et al. Circadian rhythm in typeⅠcollagen formation in postmenopausal women with and without osteopenia[J]. Osteoporos Int, 1995, 5(6):472-477.
9. Hernández MV, Guañabens N, Alvarez L, et al. Immunocytochemical evidence on the effects of glucocorticoids on typeⅠcollagen synthesis in human osteoblastic cells[J]. Calcif Tissue Int, 2004, 74(3):284-293.
10. DeFranco DJ, Glowacki J, Cox KA, et al. Normal bone particles are preferentially resorbed in the presence of osteocalcin-deficient bone particles in vivo[J]. Calcif Tissue Int, 1991, 49(1):43-50.
11. 王琳, 牛爱军. 骨代谢标志物在多发性骨髓瘤诊治中的应用现状[J]. 实用医药杂志, 2011, 28(9):844-846.
12. 阙文君, 冯正平. 骨转换生化标志物的研究进展[J]. 中国骨质疏松杂志, 2014(5):575-579.
13. Löfman O, Magnusson P, Toss G, et al. Common biochemical markers of bone turnover predict future bone loss:a 5-year follow-up study[J]. Clin Chim Acta, 2005, 356(1/2):67-75.
14. 杨国君, 吕龙. 骨转换标志物与骨质疏松症的研究进展[J]. 内蒙古医科大学学报, 2012, 34(增刊1):105-110.
15. O'brien CA. Control of RANKL gene expression[J]. Bone, 2010, 46(4):911-919.
16. Jabbar S, Drury J, Fordham JN, et al. Osteoprotegerin, RANKL and bone turnover in postmenopausal osteoporosis[J]. J Clin Pathol, 2011, 64(4):354-357.
17. Chen YH, Wu YW, Yang WS, et al. Relationship between bone mineral density and serum osteoprotegerin in patients with chronic heart failure[J]. PLoS One, 2012, 7(8):e44242.
18. Qin YJ, Zhang ZL, Zhang H, et al. Age-related changes of serum tartrate-resistant acid phosphatase 5b and the relationship with bone mineral density in Chinese women[J]. Acta Pharmacol Sin, 2008, 29(12):1493-1498.
19. 王鸿度, 陈庄, 扶世杰, 等. 骨转换生化标志物昼夜节律的研究进展[J]. 中国骨质疏松杂志, 2009, 15(12):944-948, 943.
20. 何娟文, 肖争. 骨代谢标志物研究进展[J]. 中外健康文摘, 2013(48):146-147.
21. 贾成瑶, 李萍. 尿吡啶啉和脱氧吡啶啉是骨吸收特异性生化标志物[J]. 中国临床康复, 2002, 6(15):2256-2257.
22. Halleen JM. Tartrate-resistant acid phosphatase 5B is a specific and sensitive marker of bone resorption[J]. Anticancer Res, 2003, 23(2A):1027-1029.
23. 宋志荣, 张淑琴, 阚耀东. 尿脱氧吡啶啉测定和骨密度检测对诊断骨质疏松症的对比观察[J]. 上海医学检验杂志, 2002, 17(2):105-106.
24. Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption[J]. Eur J Endocrinol, 1999, 140(4):332-337.
25. Bauer D, Krege J, Lane N, et al. National bone health alliance bone turnover marker project:current practices and the need for US harmonization, standardization, and common reference ranges[J]. Osteoporos Int, 2012, 23(10):2425-2433.
26. Vasikaran S, Eastell R, Bruyère O, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment:a need for international reference standards[J]. Osteoporos Int, 2011, 22(2):391-420.
27. 李萌, 李玉坤. 骨转换标志物及其临床应用[J]. 临床荟萃, 2014, 29(1):104-108.
28. Kindblom JM, Ohlsson C, Ljunggren O, et al. Plasma osteocalcin is inversely related to fat mass and plasma glucose in elderly Swedish men[J]. J Bone Miner Res, 2009, 24(5):785-791.
29. Eastell R, Vrijens B, Cahall DL, et al. Bone turnover markers and bone mineral density response with risedronate therapy:relationship with fracture risk and patient adherence[J]. J Bone Miner Res, 2011, 26(7):1662-1669.
30. Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women:the EPIDOS Prospective Study[J]. J Bone Miner Res, 1996, 11(10):1531-1538.
31. Manavalan JS, Cremers S, Dempster DW, et al. Circulating osteogenic precursor cells in type 2 diabetes mellitus[J]. J Clin Endocrinol Metab, 2012, 97(9):3240-3250.
32. 张金山, 罗良平. 绝经前期妇女血清PINP、ICTP和25-OH-VitD3水平的变化及其与BMD的相关性分析[J]. 放射免疫学杂志, 2010, 23(6):603-605.

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骨代谢指标物在骨质疏松症诊疗中的应用进展

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