Abstract：
Measurements of bone markers (BMs) in peripheral blood or urine are a pivotal part of bone research within modern clinical medicine. In recent years the use of BMs increased substantially as they can be useful either to diagnose bone (related) disease and to follow its natural history, but also to monitor the effects of interventions. However, the use of BMs is still complicated mainly due to (pre)analytical variability of these substances, limited accessibility of assays, variable cut-off values in different countries and laboratories and heterogeneous results with regard to clinical implications of measuring BMs in several studies. This review will provide the clinician with a practical guide, based on current evidence, in which circumstances to test which bone markers for optimal diagnostic purposes, in order to improve patient care in different areas of bone diseases including Paget\'s disease, primary osteoporosis, tumor induced osteomalacia, hypophosphatemic rickets, van Buchem disease, chronic kidney disease, rheumatoid arthritis, neoplasma/multiple myeloma, type 2 diabetes mellitus and primary hyperparathyroidism. The clinician should consider fasting state, recent fractures, aging, menopausal status, concomitant liver and kidney disease when ordering and interpreting BM measurements as these factors might result in misleading BM concentrations. We found that BMs are clearly useful in the current diagnosis of tumor induced osteomalacia, van Buchem disease, Paget\'s disease and hypophosphatemic rickets. In addition, BMs are useful to monitor disease activity in chronic kidney disease, Paget\'s disease and are useful to monitor treatment adherence in osteoporosis.
摘要：
外周血或尿液中的骨标志物（BMs）的测量是现代临床医学中骨研究的关键部分。近年来，BMs的使用大大增加，因为它们可以用于诊断骨骼（相关）疾病并跟踪其自然史。还要监测干预措施的效果。然而,BMS的使用仍然很复杂，主要是由于这些物质的（预）分析可变性，检测的可及性有限，不同国家和实验室的不同截止值以及多项研究中测量BMs的临床意义的不同结果。这篇综述将为临床医生提供实用指南，根据目前的证据,在什么情况下测试哪些骨标记物用于最佳诊断目的，为了改善患者在不同领域的骨疾病，包括佩吉特病，原发性骨质疏松症,肿瘤诱导的骨软化症，低血磷的病,vanBuchem病,慢性肾病,类风湿性关节炎,瘤/多发性骨髓瘤，2型糖尿病和原发性甲状旁腺功能亢进。临床医生应考虑空腹状态，近期骨折,老化，更年期状态，在订购和解释BM测量时，伴随肝脏和肾脏疾病，因为这些因素可能导致误导性BM浓度。我们发现BMs在目前诊断肿瘤诱导的骨软化症中明显有用，vanBuchem病,佩吉特病和低磷血症性病。此外,BMS可用于监测慢性肾脏疾病的疾病活动，Paget病，可用于监测骨质疏松症的治疗依从性。
