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

GENERAL OBJECTIVE:After finishing lab activity of bone

marker, the student will be able to describe the bone marker in the DMS

case problemSPECIFIC OBJECTIVE:

At the end of lab activity of bone marker, the student will be able to

interprete:- the normal and abnormal bone

marker

organic matrix(30% )

cells(2%) Matrix (98%)

collagen tipe 1 (95%) noncollagen protein (5%)-Osteonectin

-Osteocalcin- Bone Proteoglikan - Bone morfogenik protein

-Bone proteolipid -Bone phosfolipid

inorganic matrix(70% )

-Hidroksiapatit (95%)(Ca10(PO4)6(OH)2)

- Mg, Na, K, F, Cl, Sr, Pb (5%)

BONE PHYSIOLOGY:

BONE FORMATION AND RESORPTION

Bone turnover is characterized by twometabolic processes: Formation of new bone by osteoblast Degradation/resorption of old bone

by osteoclast

Bone mass depends on the balancedbetween 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

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

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

The specific degraded product of type 1 collagen (the C terminal telopeptides)

Increased bone resorption will cause the elevation of -crosslaps in serum

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

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

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