Bone Marker Test (Dpd) Bone Marker Test Aging is inevitable and bone reflects the aging process by exhibiting gradual loss of mass, termed osteoporosis. Bone metabolism is a delicate balance between ongoing deposition and breakdown. Hormonal balance, nutrition, lifestyle and genetics are all contributing factors to bone metabolism. Bone Remodeling: The interplay between bone formation and resorption is a continuous lifetime phenomenon. It is a dynamic process that favors bone formation in early years of life leading to a Peak Bone Mass at 30-40 years of age. From there on, the total bone mass is on a continuous decline curve-accelerated in the early post-menopausal years. The cycle of bone remodeling starts with osteoclasts eroding bone surfaces forming cavities. This results in the release of collagen degradation by-products into the circulation (Pyridinoline and Deoxypyridinoline cross-links, hydroxyproline, N-and C-collagen telopeptides). On the other hand, osteoblasts secrete bone matrix proteins, 90% of which is collagen type I with other minor proteins including osteocalcin. Osteoblasts elaborate osteocalcin, bone specific isozyme of Alkaline Phosphates and Procollagen I extension peptides, into the circulation. The final step in the cycle is the mineralization of the matrix protein by calcium salts. Additional mechanical bone tonsile strength is attained by the formation of Pyridinuum cross-links (Pyridinoline(Pyd) and Deoxypyridinoline (Dpd)) between the neighboring mature collagen fibrils.

During their lifetime, 1 in 3 women will break their hip bones.This is preventable.

Secondary Osteoporosis

Postmenopausal osteoporosis affects mainly women ages 51-65 years.

Secondary Osteoporosis (accounts for <5% of the cases) It occurs at any age secondary to several medical conditions, most of them being endocrinologic in nature: Hyperthyroidism Uncontrolled thyroid hormone replacement therapy Hyper-Cortisolic states Prolonged exogenous Glucocorticoid therapy Hypogonadism (in both sexes) *Both estradiol and testosterone regulate excessive osteoclastic activity Complete Thyroidectomy- loss of calcitonin Primary Hyperparathyroidism End-stage kidney disease Malabsorption syndromes Rheumatologic diseases and others Diagnosis of Osteoporosis The best approach to osteoporosis is prevention especially in patients who are known to be at a high risk. Presently the diagnosis of osteoporosis relies heavily on Bone densitometry (mineralized bone mass) using radioative or x-ray techniques. However, the different diagnostic modalities in use today have limitations in reliability and reproducibility and specifically in fracture-prediction capabilities.Recent technology has allowed the development of urinary assays for bone resorption markers as a complementary method to Bone Mineral Density in the diagnosis and follow-up of osteoporotic patients

Case: A woman in her 50's showed significant bone loss on both an x-ray and the urine test. A postmenopausal salivary hormone tests was give to her, she was found deficient in three hormones. Her doctor gave her a balanced hormone treatment. Nine months later her bone urine test became normal.

 This test can measure free Deoxypyridinoline.

Note: Once Pyridinoline and Deoxypyridinoline are released into the blood, they are not re-used for bone formation neither metabolized in the liver. They can be measured intact in urine. Pyridinoline is a collagen degradation product derived from several tissues in addition to bone. Deoxypyridinoline is almost exclusively specific to bone tissue. This test, Pyrilinks-D only measures free Deoxypyridinoline.

Bone Marker Tests (Dpd) Indications: 1. Preliminary screening in patients with high risks for osteoporosis. 2. Therapeutic monitoring during and after treatment for osteoporosis. 3. As an adjunct tracking tool in bone & mineralization assesment after initial densitometry is performed 4. Follow-up for monitoring efficacy of hormone replacment therapy in the prevention of osteoporosis in both sexes. 5. Hip-fracture risk prediction in the elderly 6. Metabolic bone diseases 7. Rheumatoid Arthritis and other connective tissue diseases 8. Paget's Disease 9. Bone Malignancies

The Dpd has many uses: from hip-fracture risk prediction in the elderly to metabolic bone diseases

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