Download Bone Resorption Assessment

ENDOCRINE ASSESSMENTS
Bone Resorption Assessment
Why is this test important?
Hormone Tests
The most complete line of endocrine testing
Next to cardiovascular disease, osteoporosis is the most common disease affecting
women in the U.S. today. More than 50% of healthy American women aged 30-40 are at
risk of developing fractures as they age due to osteoporosis.
Bone loss usually begins as early as the fourth decade of life. Early assessment and intervention is essential for preventing osteoporosis in later years.
Unlike bone scans, this test can identify current levels of bone resorption. This is the most
specific bone resorption analysis available.
Many factors influence bone resorption. This test is useful in monitoring the effectiveness
of calcium supplementation, biphosphonate therapy, and other treatment programs.
What does this test involve?
A urine sample is collected after the first morning urine has been discarded.
The report includes urinary levels of pyridinium crosslinks. Pyridinium crosslinks consist
of deoxypyridinoline (DPD) and pyridinoline (PYD). DPD is found predominantely in bone
tissue, whereas PYD is found in bone and cartilage.
When combined with a Dexa or similar bone scan, this test provides a picture of current
bone density AND the dynamics of bone resorption.
What does this test measure?
Pyridinium crosslinks stabilize collagen molecules. As bone resorbs, these crosslinks are
excreted into the urine. Urinary levels thus indicate the degree of current bone loss.
INTERPRETIVE
GI U I D E L I N E S
NTERPRETIVE
GUIDELINES
Deoxypyridinoline & Pyridinium
Analyte
Deoxypyridinoline &
Pyridinium
(If both elevated
Deoxypyridinoline (DPD) and
Pyridinium crosslinks or only
elevated DPD )
Suspect
• Increased bone resorption
(DPD specifically reflects bone)
Analyte
Deoxypyridinoline &
Pyridinium
(If only elevated Pyridinium
crosslinks [DPD Normal])
Suspect
• Increased bone and cartilage resorption
PYD reflects both bone and cartilage
Possible causes:
• Rheumatoid arthritis
Levels of PYD often correlate with disease
activity
• Other connective tissue disorders
• Chronic alcohol ingestion
Possible causes:
• Reduced estrogen production
(menopause, amenorrhea, oophorectomy)
• Physiologic states and diseases
Hyperparathyroidism, hyperthyroidism,
osteomalacia, Paget's disease, Cushing's
disease, rheumatoid arthritis, osteoarthritis,
cancer (bone metastasis), primary biliary
cirrhosis, COPD, diabetes mellitus
• Lifestyle factors
Smoking, emotional stress, lack of weightbearing exercise or sunlight
• Dietary factors
Excess meat, protein, carbonated soft drinks,
coffee, sugar, salt or alcohol; insufficiencies of
bone-supporting nutrients
• Medications
Corticosteroids, anticonvulsants,
anticoagulants, antacids, lithium, some
chemotherapies, some diuretics
• Hypochlorhydria, malabsorption
• Toxic metal exposure (esp. Al, Pb, Cd, Sn)
• Genetic predisposition
• Fracture
Consider
• Correct amenorrhea, consider post-menopausal
hormone replacement therapy
(e.g. estrogen, progesterone, DHEA, testosterone)
and/or natural hormone promoters such as: ginseng,
dong quai, licorice, alfalfa, black cohosh, wild yam
• Address any underlying disorders
• Address lifestyle factors:
Increase weight-bearing exercise, sunlight
Reduce smoking, improve stress management
• Identify and correct heavy metal toxicities
Consider Elemental Analysis (hair, urine, or blood)
• Ensure adequate supply of bone-supporting
nutrients: Microcrystalline hydroxyapatite (MCHC),
Ca, Mg, Zn, Cu, silicon, strontium, boron, Mn, folic
acid, and vitamins D, K, B6, B12, and C (Note: taking
Ca at bedtime can dramatically reduce crosslink
excretion)
MCHC is a bone tissue supplement containing Ca
and other bone trace minerals
Consider Elemental Analysis to assess nutrient
status
• Address dietary factors:
Reduce meat, acid-ash foods, processed foods,
carbonated beverages, salt, sugar, coffee, alcohol
Increase whole grains, vegetables (esp. dark green
leafy vegetables), fiber, soy foods (isoflavones),
foods high in Ca and Mg, EFAs (esp. omega-3s)
• Ensure proper digestion and assimilation
Consider Comprehensive Digestive Stool Analysis,
and/or Intestinal Permeability Assessment, to rule
out maldigestion or malabsorption
• Remove antacids, evaluate other medications’
contribution to bone loss
Consider
• Identify and address underlying disorder:
Consider Oxidative Stress Analysis and
Detoxification Profile (poor detoxification and
free radical damage often correlate with connective
tissue disorders)
This information is for the sole use of a licensed health care practitioner and is for educational purposes only.
It is not meant for use as diagnostic information. All claims submitted to Medicare/Medicaid for Genova
Diagnostics laboratory services must be for tests that are medically necessary. “Medically necessary” is defined
as a test or procedure that is reasonable and necessary for the diagnosis or treatment of illness or injury or to
improve the functioning of a malformed body member. Consequently, tests performed for screening purposes
will not be reimbursed by the Medicare program.
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