Die Rolle der Knochenumbaumarker bei Knochenmetastasen

M. J. Seibel

doi:10.1055/s-0037-1619879

Osteologie, Table of Contents

Osteologie 2009; 18(01): 24-34
DOI: 10.1055/s-0037-1619879

Osteologie und Labor

Schattauer GmbH

Die Rolle der Knochenumbaumarker bei Knochenmetastasen^[*]

Bone turnover markers and bone metastases

M. J. Seibel^**

¹Bone Research Program, ANZAC Research Institute, University of Sydney, and Department of Endocrinology & Metabolism, Concord Hospital, Concord, Sydney, Australia

› Author Affiliations

Abstract

Zusammenfassung

Biochemische Marker des Knochenstoffwechsels werden heute in der klinischen Praxis immer häufiger eingesetzt. Auf dem Gebiet der Onkologie stehen diese Marker mit dem Auftreten, der Prognose und dem Ansprechen auf therapeutische Interventionen maligner Knochenläsionen in Verbindung. So sind z. B. Marker des Knochenabbaus häufig bei Patienten mit ossären Metastasen erhöht. Obwohl angesichts dieser Befunde postuliert werden könnte, dass diese Marker in der Diagnostik von Tumorpatienten von Nutzen sein könnten, lässt die derzeitige Datenlage keine abschließende Beurteilung über die Genauigkeit und Gültigkeit der gegenwärtig eingesetzten Marker in der Früherkennung von Knochenmetastasen zu. Infolge der antiresorptiven Wirkung der Bisphosphonate können biochemische Marker des Knochenumbaus zur Therapiekontrolle beziehungsweise als prognostischer Marker hinzugezogen werden. Jedoch bleibt bis dato unbekannt, ob die Verwendung von Knochenmarkern in der klinischen Routine bei Tumorpatienten auch einen Einfluss auf den Heilungsverlauf bzw. der Langzeitprognose hat. Die Knochenmarker haben einen unzureichenden diagnostischen und prognostischen Wert, um alleinig verwendet werden zu können. Die Kombination dieser Marker mit anderen diagnostischen Techniken könnte jedoch die klinische Beurteilung von Patienten mit Tumorarten, die in die Knochen metastasieren, verbessern.

Summary

Biochemical markers of bone turnover are widely used in clinical practice. In the field of oncology, these markers have been shown to be associated with the occurence, prognosis and therapeutic response of malignant bone lesions. For example, markers of bone resorption are often elevated in patients with established bone metastases and while this may point to a role of these markers in the diagnostic workup of cancer patients, the available evidence does not permit any final conclusions as to the accuracy and validity of the presently used markers in the early diagnosis of bone metastases. Many bone turnover markers appear to respond to anti-resorptive and antineoplastic therapies, and recent evidence from prospective trials suggests that the aim of bisphosphonate therapy should be to normalize rates of bone remodelling to optimise therapeutic and prognostic outcomes. However, it remains unknown whether the use of bone markers in the routine clinical setting has any defined beneficial effect on overall outcome in cancer patients. Clearly, bone turnover markers have insufficient diagnostic or prognostic value to be used in isolation; however, the combination of these markers with other diagnostic techniques may improve clinical assessment of patients with bone seeking cancers.

Schlüsselwörter

Knochenumbaumarker - Knochenmetastasen - Diagnostik von Tumorpatienten

Keywords

Biochemical markers of bone turnover - bone metastases - diagnostic workup of cancer patients

Full Text

References

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Die Rolle der Knochenumbaumarker bei Knochenmetastasen[*]

Die Rolle der Knochenumbaumarker bei Knochenmetastasen^[*]