European Journal of Pediatrics

, Volume 145, Issue 1–2, pp 27–33 | Cite as

Evaluation of serum osteocalcin as an index of altered bone metabolism

  • K. Kruse
  • U. Kracht
Original Investigations


Recent evidence suggests that the protein osteocalcin is like the bone alkaline phosphatase produced by osteoblasts and circulates in human blood. With the introduction of a radioimmunoassay for serum osteocalcin it was hoped that this test would provide a useful index of altered bone metabolism. Therefore serum osteocalcin was measured in 88 controls and 112 patients with disorders of calcium and phosphate metabolism, isolated elevation of alkaline serum phosphatase in the absence of disease (isolated hyperphosphatasaemia) and children prone to osteopenia.

In the controls serum osteocalcin was higher in children<15 years (median and range: 11.9, 7.7–15.3 ng/ml) than in adults (3.7, 2.6–5.2 ng/ml) and was highly correlated to alkaline serum phosphatase activity (r=0.87, n=88, P<0.01). Osteocalcin was elevated in primary hypoparathyroidism, low in untreated hypoparathyroidism but normal in hypoparathyroidism (including pseudohypoparathyroidism) during vitamin D treatment. The bone protein was low-normal and increased to high-normal levels during vitamin D therapy in vitamin D deficiency rickets and familial hypophosphataemic rickets, but remained low in patients with end organ resistance to 1,25-dihydroxyvitamin D. Osteocalcin (and urinary hydroxyproline) were not elevated in isolated hyperphosphatasaemia, indicating that mechanisms other than increased bone turnover may account for the markedly elevated serum alkaline phosphatase activity in these subjects. Osteocalcin was decreased in children with diabetes mellitus type I and in patients on glucocorticoid treatment, indicating decreased bone formation. It is concluded that the measurement of serum osteocalcin seems to be a reliable index of bone formation provided that the vitamin D status and renal function are normal. Although serum osteocalcin and alkaline phosphatase were generally correlated there were examples of dissociation between both indices. In some circumstances (e.g. rickets) serum osteocalcin may severe as a useful index of an effective therapy.

Key words

Gammacarboxy-glutamic acid Hyperparathyroidism Osteocalcin Rickets 



alkaline phosphatase activity


gammacarboxy-glutamic acid

1,25 (OH)2D3





parathyroid hormone






primary hyperparathyroidism


vitamin D deficiency rickets


vitamin D dependency rickets type II


familial hypophosphataemic rickets


isolated hyperphosphatasaemia in the absence of disease


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Copyright information

© Springer-Verlag 1986

Authors and Affiliations

  • K. Kruse
    • 1
  • U. Kracht
    • 1
  1. 1.Universitäts-KinderklinikWürzburgFederal Republic of Germany

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