Summary
A continuous bone remodelling takes place throughout life at different turnover speed according to age, physiological and pathological conditions. The evaluation of bone turnover may be of value for a prognostic and therapeutical assessment. Calcium bone exchange may be considered a suitable marker of bone turnover; for this reason47Ca or45Ca kinetics may be used; these methods have been employed in the past. Labelled diphosphonates, and in particular99Tecnetium-metilen-diphosphonate (99TcmCP) are simpler and safer, because these substances are strongly and almost completely stored in bone and not absorbed by the soft tissue; for this reason they are used at the present time. The evaluation of blood levels and 24 hrs urinary elimination of99TcmDP is used to measure whole bone diphosphonate retention (WBR). This parameter is positively correlated with other markers of bone turnover such as alkaline phosphatase (AP), osteocalcin (OC), urinary hydroxyproline (HOP). A bicompartimental analysis schedule of99TcmDP distribution has been proposed some years ago and therefore applied by our group, based on the mathematical evaluation of serum concentration at different times and urinary elimination of the label given intravenously. This method provides the possibility to calculate not only WBR but also total body retention (TBR) and a constant (Kbh) which reflects the influx speed of the tracer in the bone. Kbh probably represents a more sensitive index of bone turnover than WBR. It presents a better correlation with AP and OC values and also shows some (statistically less significant) correlations with some indices of bone remodelling obtained by hystomorphometry on bone biopsies. Kbh is fairly stable in rest conditions and is elevated in high bone turnover conditions (Paget, osteomalacia and, at a lower extent, high turnover osteoporosis).
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References
Aubert, J.P., Milhaud, G., Methode de mesure des principales voies du metabolisme calcique chez l'homme. Biochim Piophys Acta 1960, 39, 122.
Fleisch, H., Chemistry and mechanism of action of Biphosphonates. In: Bone Resorption, Metastasis, and Diphosphonates. Ed: S. Garattini. Raven Press Publ., New York 1985, pp. 33–40.
Shinoda, H., Adamek, G., Felix, R., Schenk, R., Hagan, P., Structure-activity relationships of various biphosphonates, Calcif Tissue Int 1982, 34, 58–69.
Powell, J.H., Demark, B.R. Clinical pharmacokinetics of diphosphonates. Ed: S. Garattini. Raven Press Publ., New York 1985, pp. 33–40.
Tofe, A.J., Francis, M.D. Optimization of the ratio of stannous tin: ethane-l-hydroxy-1,1-diphosphonate for bone scanning with 99mTc-pertechnetate. J Nucl Med 1974, 15, 69–74.
Fogelman, I., Bessent, R., Turner, J.C., et al. The use of whole-body retention of Tc-99m diphosphonate in the diagnosis of metabolic bone diseases, J Nucl Med 1978, 19, 270–275.
Podenphant, J., Johansen, J.S., Thomsen, K. et al. Bone turnover in spinal osteoporosis. J Bone Min Res 1987, 2, 497–502.
Christiansen, C., Rodbro, P. Estimation of total body calcium from the bone mineral content of the forearm. Scand J Clin Lab Invest 1975, 35, 425–431.
Yakatan, G.J., Poynor, W.J., Talbert, R.L. et al., Clodronate kinetics and bioavailability. Clin Pharmacol Ther 1982, 31, 402–410.
Caniggia, A., Vattimo, A., Kinetics of 99m technetium-tin-methylene-diphosphonate in normal subjects and pathological conditions: a simple index of bone metabolism. Calcif Tissue Int 1980, 30, 5–13.
Passeri, M., Palummeri, E., Di Ruvo, R., Carbognani, A., Osteoporosi ad alto e basso turnover: fasi o forme diverse di malattia? In: Osteoporosis: social and clinical aspects, Ed: C. Gennari, G. Segre. Excerpta Medica, Amsterdam 1984, pp. 200–210.
Greenblatt, D.J., Koch-Weser, J., Clinical Pharmacokinetics (First of two parts). N Engl J Med 1975, 293, 702–705.
Notari, R.E., In: Biopharmaceutics and pharmacokinetics: an introduction, Ed: Notari R.E. M. Dekker, New York 1975, pp. 72–73.
Villanueva, A.R., A bone stain of osteoid seams in fresh unembedded mineralized bone, Stain Technol 1974, 49, 1–8.
Podenphant, J., Gotfredsen, A., Nilas, L. et al. Iliac crest biopsy: an investigation of certain aspects of precision and accuracy, Bone Mineral 1986, 1, 279–287.
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Passeri, M., Palummeri, E., Baroni, M.C. et al. Isotope retention for assessment of bone turnover in involutional osteoporosis. Clin Rheumatol 8 (Suppl 2), 35–40 (1989). https://doi.org/10.1007/BF02207231
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DOI: https://doi.org/10.1007/BF02207231