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Bone Marker Mean Decrease (%) Correlation (r) with BMD Increase P Osteocalcin
BSAP
NTx -38
-38
-65 -
-
-

BMD, bone mineral density; BSAP, bone-specific alkaline phosphatase; NTx, collagen cross-linked N-telopeptide. CTx response to HRT: mean decrease = -43%; correlation (r) with BMD increase = -, P = . 23
In side-by-side studies, the magnitude of decrease in CTx is similar to that of NTx. 24 Levels of bone turnover markers are affected by marker specificity for bone collagen and metabolic clearance (liver uptake, renal excretion, etc.), and thus are of unequal sensitivity and specificity. Estimates of net excess of bone resorption over bone formation may be misleading; however, either bone formation or bone resorption markers will reflect the overall rate of bone turnover. Bone marker levels are also affected by the timing of sample collection due to diurnal variation (early morning peak and afternoon nadir). Intra-individual biological variations range from a low of 20% in NTx to a high of 53% in hydroxyproline. 28 Interpretation is highly dependent on the specific marker and method of analysis used. Bone Formation Markers Osteocalcin is the major non-collagenous matrix protein of bone. Serum levels are increased in primary and secondary hyperparathyroidism, secondary osteosarcoma, healing bone fractures, hyperthyroidism, Paget disease, acromegaly, impaired renal glomerular function and renal failure, and in response to coumarin anticoagulants, slow-release sodium fluoride, phenytoin and 1,25-dihydroxyvitamin D. Osteocalcin is also increased in elderly men (>60 years) and postmenopausal women. Levels in Mexican-Americans are generally increased relative to non-Hispanic Caucasians. 27

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