GUIDELINE 2004 2004 1 1993 2000NIH 1) compromized bone strength bone mineral densitybmdbone quality 2,3) BMDBMD 4) 2 BMD DXA 5) 11(191)
6) QOL 3 BMD 7) 810) 11,12) 13) 1416) 2001 2004 4 2001 17) 2002 18) BMD 2 BMD BMD NIH 1) 12(192)
12004 BMD I 3 II. 1 DPD 1DPD DPD 40 60 I 13(193)
1I I N NTX I C CTX DPDNTXCTX 1990 I 199912 DPD NTX DPD TM TM ELISA 2003 CTX TM DPD NTXCTXNTX NTx TM 2002 2 3ALP ALP 14(194)
2 I 3 ALP50 50BAP BAP BAP BAP TM EIA TM IRMA 15(195)
61 CTX I N PINP 1 III. BMD BMD QOL BMD BMDQOL 19,20) BMD 21) BMD BMD 16(196)
22) IV. 1 DPDNTXCTX CTX NTXPINPBAP DPDNTXCTX 1 6wash out 2 18,23) 24) 1.96SD 2 3 3 25 3 1.0SD 3 17(197)
2 3 1.96SD 4 4 4 DPDNTXCTX SERM) D 3 18(198)
4 4 6 SERM 5 1 19(199)
5 minimum significant change: MSC 6 1 2 3 4 SERM DPDNTXCTXBAPPINP 26,27) DPD 11,28) minimum significant changemsc MSC 2 5 2 MSC 6 DPD NTX CTXBAPPINP K 2 (ucoc) 20(200)
5 NTX MSC NTX nmolbce/mmolcr 2 DPDNTXCTX 3 6 2 BAPPINP 6 2 2 3 3 29 2 MSC 5 NTX V. BAP, DPD, NTXCTX 21(201)
29,30 2,7 22(202)
1) NIH Consensus Development Panel on Osteoporosis Prevention. Diagnosis and Therapy. JAMA 2001;285:785 95. 2) Weinstein RS. True strength. J Bone Miner Res 2000;15:621 5. 3) Chesnut III CH, Rosen CJ for the Bone Quality Discussion Group. Reconsidering the effects of antiresorptive therapies in reducing osteoporotic fracture. J Bone Miner Res 2001;16:2163 72. 4) Marcus R, Wong M, Heath III H, et al. Antiresorptive treatment of postmenopausal osteoporosis: comparison of study designs and outcomes in large clinical trials with fracture as an endpoint. Endocrine Rev 2002;23:16 37. 5) Orimo H, Hayashi Y, Fukunaga M, et al. Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 2001;19:331 7. 6) Cummings SR, Karpf DB, Harris F, et al. Improvement of spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 2002;112:282 9. 7) Heaney RP. Is the paradigm shifting? Bone 2003;33:457 65. 8) Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women; EPIDOS prospective study. J Bone Mineral Res 1996;11:1531 8. 9) Garnero P, Sornay Rendu E, Claustrar B, et al. Biochemical markers of bone turnover, endogenous hormones and the risk of fracture in postmenpausal women: the OFELY study. J Bone Miner Res 200;15:1526 36. 10) Ross PD, Kress BC, Parson RE, et al. Serum bone alkaline phosphatase and calcaneus bone density predict fractures; a prospective study. Osteoporos Int 2000;11:76 82. 11) Shiraki M, Kushida K, Fukunaga M for the Alendronate Phase Osteoporosis Research Group. A double masked multicenter comparative study between alendronate and alfacalcidol in Japanese patients with osteoporosis. Osteoporos Int 1999;10:183 92. 12) Morii H, Ohashi Y, Taketani Y, et al. Effect of raloxifene on bone mineral density and biochemical markers of bone turnover in Japanese postmenopausal women with osteoporosis: results from a randomized placebo controlled trial. Osteoporos Int 2003;14:793 800. 13). Osteoporosis Jpn 2003;11:631 43. 14) Miller PD, Baran DT, Bilezikian JP, et al. Practical clinical application of biochemical markers of bone turnover: consensus of an expert panel. J Clin Densitom 1999;2:323 42. 15) Delmas PD, Eastell R, Garnero P et al. A position paper on the use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int 2000;10 (Suppl.6):S2 7. 16) Looker A, Bauer DC, Chesnut C III et al. Clinical use of biochemical markers of bone remodeling: current status, future directions. Osteoporos Int 2000;11:467 80. 17) 2001. Osteoporosis Jpn 2001;9:255 71. 18) 2002. Osteoporosis Jpn 2002;10:251 61. 19) Bjarnason NH, Sarker S, Duong T, et al. Six and twelve month changes in bone turnover are related to reduction in vertebral fracture risk during 3 years of raloxifene treatment in postmenpausal osteoporosis. Osteoporos Int 2001;12:922 30. 20) Eastell R, Barton I, Hannon RA, et al. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 2003;18:1051 6. 21) Delmas PD, Seeman E. Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti resorptive therapy. Bone (in press), 2004. 22) Delmas PD, Vrijens B, Roux C, et al. A reinforcement message based on bone turnover marker response influences long term persistence with risedronate in osteoporosis: IMPACT study. J Bone Miner Res 2003;18(Suppl 2):S374. 23). I N NTX I N PINP. Osteoporosis Jpn 2002;10:539 44. 24). 23(203)
Osteoporosis Jpn 2003;11:201 4. 25) Clinical Calcium 2001;11:1572 6. 26). 2001;19:63. 27). I N PINP I N (PINP). Osteoporosis Jpn 2004;12:219 24. 28) Greenspan SL, Parker RA, Ferguson L, et al. Early changes in biochemical markers of bone turnover predict the long term response to alendronate therapy in representative elderly women: a randomized clinical trial. J Bone Miner Res 1998;13:1431 8. 29) Eastell R, Brainbridge PR. Bone turnover markers: their place in the investigation of osteoporosis. In: Osteoporosis: Pathophysiology and clinical management (eds by Orwoll ES, Bliziotes M). Humana Press Totowa, NJ, 2003. pp185 197. 30) 1 2002;50:419 25. 31) Osteoporosis Jpn 2004;12:214 8 24(204)
1 IOF 1 K 172124 3 Gla BGPbone gla protein N IOF BGP OC OC GlaGlaundercarboxylated osteocalcin uncarboxylated osteocalcin CSA IOF ucoc 2 ALP 25(205)
ALP ALP CSA IOF ALP BAP 3I I IN C II I N PINP I C PICP 4 12 14 HypPYD DPD I N C I N NTXNTX I I I C CTXCTX I I MMPIC I C CSA IOFCTX MMPICTP 5 ACP TRACP5a 5b5b TRACP 5b 26(206)
2MSC 3 27(207)