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Insights on Bone Metabolism
Hormones such as parathyroid hormone (PTH), vitamin D, estrogen, and calcitonin play crucial roles in regulating bone turnover. Vitamin D is a fat-soluble steroid hormone precursor that is mainly produced in the skin by exposure to sunlight. It’s biologically inert and must undergo two successive hydroxylations in the liver and kidney to become the biologically active 1,25‑dihydroxyvitamin D. The monitoring of vitamin D is helpful in diseases where calcium and phosphorus homeostasis or bone metabolism are altered. In children, severe deficiency leads to bone-malformation, known as rickets. Vitamin D deficiency causes muscle weakness; in elderly, the risk of falling has been attributed to the effect of vitamin D on muscle function. The two most important forms of vitamin D are vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). In contrast to vitamin D3, the human body cannot produce vitamin D2, which is taken up with fortified food or given by supplements.
N-terminal telopeptide (NTx) measurement is a laboratory test used to assess bone resorption, reflecting the rate at which bone collagen is being degraded. NTx fragments are released into the bloodstream or urine during the breakdown of type I collagen, the main structural protein of bone. It’s therefore used as a biomarker of bone turnover.
Bone metabolism is a tightly regulated process essential for skeletal integrity and mineral balance, and its disruption is a major driver of metabolic bone diseases.
1 billion
people globally are estimated to have vitamin D deficiency
10%
of the adult skeleton is remodeled each year
40%
higher fracture risk linked to vitamin D deficiency
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Instruments for diagnosing Bone Metabolism
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References
a) Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, Martucci G, Pilz S, Malle O. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020 Nov;74(11):1498-1513.
b) Holick MF. Vitamin D deficiency. N Engl J Med. 2007 Jul 19;357(3):266-81.
c) Hart NH, Newton RU, Tan J, Rantalainen T, Chivers P, Siafarikas A, Nimphius S. Biological basis of bone strength: anatomy, physiology and measurement. J Musculoskelet Neuronal Interact. 2020 Sep 1;20(3):347-371.
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