Clinical pathology: BONE MARKER GENERAL OBJECTIVE: After finishing lab activity of Bone Marker, the student will be able to describe the Bone Marker in the DMS case problem SPECIFIC OBJECTIVE: At the end of lab activity of Bone Marker , the student will be able to interprete: - the normal of Bone Marker - the abnormal of Bone Marker

CLINICAL PATHOLOGY: BONE MARKER GENERAL OBJECTIVE: After finishing lab activity of bone marker, the student will be able to describe the bone marker in the DMS case problem SPECIFIC OBJECTIVE: At the end of lab activity of bone marker, the student will be able to interprete: - the normal and abnormal bone marker

BONE PHYSIOLOGY:

BONE FORMATION AND RESORPTION Bone turnover is characterized by two metabolic processes: Formation of new bone by osteoblast Degradation/resorption of old bone by osteoclast Bone mass depends on the balanced between bone formation and resorption

Bone formation can be assessed by determination of: Total /Bone specific alkaline phosphatase and osteocalcin Bone resorption can be assessed by determination of pyridinoline, cross linked N telopeptide and C terminal telopeptide (-crosslaps)

Osteocalcin

OSTEOCALCIN The most important non-collagen protein (Bone specific peptide) Synthesize by osteoblast (marker bone turnover) After release from osteoblast, assimilated into bone matrix and also secreted to the bloodstream

OSTEOCALCIN Specimen: serum or plasma Reference range: Male 18 - < 30 years: 24 – 70 ng/mL 30 - 50 years: 14 – 42 ng/mL >50 - 70 years: 14 – 46 ng/mL Female Premenopause> 20 years: 11 – 43 ng/mL Postmenopause : 15 – 46 ng/mL

 Crosslaps

-CROSSLAPS The specific degraded product of type 1 collagen (the C terminal telopeptides) Increased bone resorption will cause the elevation of -crosslaps in serum

Struktur Bentuk Deoksidipiridinolin, C Terminal Cross Linked Telopeptide dan N Terminal Cross Linked Telopeptide

-CROSSLAPS Specimen: serum Reference range: Male 30 - 70 years: 0.016 – 0.584 ng/mL >70years : 0.104 – 0.854 ng/mL Female Premenopause : 0.025 – 0.573 ng/mL Postmenopause : 0.104 – 1. 008 ng/mL

Alkaline Phosphatase (ALP)

ALKALINE PHOSPHATASE An enzyme located in osteoblast, liver , intestine, kidney and placenta Function: activate the chemical reaction in in cells which the enzyme located High concentration of ALP → specific organ has increased the production or release this enzyme ( bone or liver) The causes of elevated ALP from bone disease → no elevation of ALT or AST

ALKALINE PHOSPHATASE Specimen: serum Reference range: 370C Male < 129 U/L Female < 104 U/L Children higher (depends on age)