Selected Markers of Bone Turnover
Clinical
Biochemistry
(Scroll down for stability of bone markers under different conditions)

Selected Markers Of Bone Turnover
Bone Formation Bone Resorption
Plasma Bone Specific ALP
P1NP
ALP
Osteocalcin
CTX
Urine PYR and DPD

Changes in biochemical markers of bone turnover in metabolic bone disease
Use Bone Formation Bone Resorption
Osteoporosis Increased or normal Increased or normal
Osteoporosis, monitoring
antiresorptive therapy
Decrease by 30% from baseline to be effective Decrease by >50% from baseline to be effective
Corticosteroids on bone Osteocalcin decrease Small effect on resorption markers depending on duration of treatment
Myeloma May be low, normal or increased, depending on
therapy and recent fractures
Greatly increased
Chronic Renal Failure Normal or increased (especially osteocalcin,
due to
decreased renal excretion)
Normal or increased
Pagetís disease Increased (especially
ALP and BSALP)
Increased, according to activity of disease
Fracture
(Depends on location of fracture)
Increased for up to a year Increased for up to 6 months
Osteomalacia Often increased Often increased
Primary hyperparathyroidism Often increased Often increased

Stability of bone markers under various sample handling and storage conditions


 
    Whole blood      
Separated plasma or serum

Analyte  Specimen type
RT
RT
2-8oC

β-CTX  Lithium heparin 
4 h
4 h
<24 h
EDTA* 
48 h
48 h
7 d
Serum 
4 h
8 h
48 h

P1NP  Lithium heparin 
48 h
7 d
28 d
EDTA 
48 h
7 d
28 d
Serum 
48 h
7 d
28 d

Osteocalcin  Lithium heparin 
2 h
2 h
24 h
EDTA* 
8 h
8 h
7 d
Serum 
1 h
2 h
24 h

PTH  Lithium heparin* 
8 h
48 h
28 d
EDTA* 
48 h
48 h
28 d
Serum 
4 h
8 h
48 h

Bone ALP  Serum 
24 h
7 d
28 d

* Recommended specimen type