1. 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

2. 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

3. BONE PHYSIOLOGY:

4. 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

6. 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)

7. Osteocalcin

8. 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

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

10.  Crosslaps

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

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

13. -CROSSLAPS Specimen: serum Reference range: Male
years: – ng/mL
>70years : – ng/mL
Female
Premenopause : – ng/mL
Postmenopause : – ng/mL

14. Alkaline Phosphatase (ALP)

15. 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

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