Clinical pathology: BONE MARKER

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Clinical pathology BONE MARKER

• GENERAL OBJECTIVE
• After finishing lab activity of Bone Marker,
  the student will be able to describe the Bone
  Marker in the DMS case problem
• SPECIFIC OBJECTIVE
• At the end of lab activity of Bone Marker ,
  the student will be able to interprete
• - the normal of Bone Marker
• - the abnormal of Bone Marker

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CLINICAL PATHOLOGYBONE MARKER

• GENERAL OBJECTIVE
• After finishing lab activity of bone marker, the
  student will be able to describe the bone marker
  in the DMS case problem
• SPECIFIC OBJECTIVE
• At the end of lab activity of bone marker, the
  student will be able to interprete
• - the normal and abnormal bone marker

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BONE PHYSIOLOGY
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• BONE FORMATION AND RESORPTION
• Bone turnover is characterized by two
• metabolic processes
• Formation of new bone by osteoblast
• Degradation/resorption of old bone by osteoclast
• Bone mass depends on the balanced
• between bone formation and resorption

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• Bone formation can be assessed by determination
  of Total /Bone specific alkaline phosphatase and
  osteocalcin
• Bone resorption can be assessed by determination
  of pyridinoline, cross linked N telopeptide and C
  terminal telopeptide (?-crosslaps)

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Osteocalcin
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OSTEOCALCIN

• The most important non-collagen protein (Bone
  specific peptide)
• Synthesize by osteoblast (marker bone turnover)
• After release from osteoblast, assimilated into
  bone matrix and also secreted to the bloodstream

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OSTEOCALCIN

• Specimen serum or plasma
• Reference range
• Male
• 18 - lt 30 years 24 70 ng/mL
• 30 - 50 years 14 42 ng/mL
• gt50 - 70 years 14 46 ng/mL
• Female
• Premenopausegt 20 years 11 43 ng/mL
• Postmenopause 15 46 ng/mL

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? Crosslaps
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?-CROSSLAPS

• The specific degraded product of type 1 collagen
  (the C terminal telopeptides)
• Increased bone resorption will cause the
  elevation of ?-crosslaps in serum

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Struktur Bentuk Deoksidipiridinolin, C Terminal
Cross Linked Telopeptide dan N Terminal Cross
Linked Telopeptide
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?-CROSSLAPS

• Specimen serum
• Reference range
• Male
• 30 - 70 years 0.016 0.584 ng/mL
• gt70years 0.104 0.854 ng/mL
• Female
• Premenopause 0.025 0.573 ng/mL
• Postmenopause 0.104 1. 008 ng/mL

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Alkaline Phosphatase (ALP)
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ALKALINE PHOSPHATASE

• An enzyme located in osteoblast, liver ,
  intestine, kidney and placenta
• Function activate the chemical reaction in in
  cells which the enzyme located
• High concentration of ALP ? specific organ has
  increased the production or release this enzyme (
  bone or liver)
• The causes of elevated ALP from bone disease ?
  no elevation of ALT or AST

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ALKALINE PHOSPHATASE

• Specimen serum
• Reference range 370C
• Male lt 129 U/L
• Female lt 104 U/L
• Children higher (depends on age)