Knochenumbaumarker und ihre klinische Anwendung bei Osteoporose

Zusammenfassung

Im klinischen Alltag steht uns heute eine breite Palette von Knochenumbaumarkern zur Verfügung, die, je nach Stoffwechselvorgang den sie widerspiegeln, in Knochenformationsbzw. Knochenresorptionsmarker eingeteilt werden. Diese biochemischen Indizes können bei korrekter Anwendung und Interpretation zur diagnostischen und therapeutischen Beurteilung von metabolischen Knochenerkrankungen hilfreich sein. Basierend auf Beobachtungs- und Interventionsstudien hat sich gezeigt, dass erhöhte Spiegel von Knochenumbaumarkern, unabhängig von der Knochendichte, mit einem erhöhten Frakturrisiko vergesellschaftet sind. Zudem können Knochenmarker bei der Überwachung einer medikamentösen Behandlung hilfreich sein, um so die Wirksamkeit einer antiresorptiven bzw. knochenanabolen Behandlung sowie die Therapietreue der Patienten zu beurteilen. Im Gegensatz dazu können Knochenmarker nicht zur Diagnose einer Osteoporose herangezogen werden. Um die präanalytische und analytische Variabilität der Messresultate zu verringern, ist eine standardisierte Probenentnahme (Serum oder Urin) sowie die Bestimmung in einem für Knochenmarker spezialisierten Labor unter strenger externer Qualitätskontrolle erforderlich.

Summary

Biochemical markers which specifically reflect either bone formation or bone resorption are helpful tools in the diagnostic and therapeutic assessment of metabolic bone disease. Bone turnover markers can be used to estimate fracture risk in postmenopausal women and older men, independent from BMD. The major domain for the use of bone turnover markers in clinical practice is the monitoring of antiosteoporotic therapy, treatment efficacy and patient compliance. In contrast, however, bone markers cannot be used for diagnosis of osteoporosis. Measurements of markers of turnover are subject to considerable pre-analytical and analytical variability, and this problem presents a major issue in the management of osteoporosis in the clinical setting. Hence, standardisations of serum and urine collection, as well as measurement of bone markers in specialised laboratories that participate in an external quality assurance programme are mandatory.

Schlüsselwörter

Osteoporose - Knochenumbaumarker - Frakturrisiko

Keywords

Osteoporosis - bone turnover markers - fracture risk

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