Analytical and Preanalytical Issues in Measurement of Biochemical Bone Markers

Hubert W. Vesper, PhD


Lab Med. 2005;36(7):424-429. 

In This Article


Bone markers are useful tools for managing bone diseases because they provide information that differs from but complements bone mineral density measurement. Problems in the measurement and interpretation of bone marker values continue to hamper the optimal utility of this clinical tool.

Most of these difficulties originate from problems related to the handling and control of analytical and biological variability of bone marker measurements. These sources of variability can be substantial and need to be controlled.

Certain bone markers or bone marker tests may require special considerations, such as analyte stability. Guidelines for minimizing preanalytical variability have been developed, and the means to minimize the analytical variability for some bone markers are available.

Measurement of biochemical bone markers is a tool commonly used in clinical research on metabolic bone diseases. Because research findings in this area are applied increasingly in clinical practices, bone markers are used more and more in routine clinical testing.[1,2,3,4,5,6,7] Although clinical research is performed in highly controlled and standardized settings with well-defined patients, routine clinical testing deals with less controlled and defined circumstances ( Table 1 ). Therefore, knowledge of these factors affecting results of bone marker measurements is important so that this tool is applied appropriately and interpretation of results in routine clinical testing is facilitated. This review summarizes biochemical bone markers and provides an overview of analytical and preanalytical factors that affect bone marker measurements.


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