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Thermodegradation
4C and 20C, and have been shown to not change significantly during repeated freezethaw-cycles.124 However, when samples are being exposed to temperatures above 30C,
an increase in signal is usually seen with the RIA.
Some assays and marker components are sensitive to haemolysis of the sample, resulting
in results that are either too low or too high. This is usually the case for OC and BSP, but
has also been described for TRAP and some other serum markers.
It is long known that bone turnover and thus bone markers show significant diurnal
variations, with highest values in the early morning hours and lowest values during the
afternoon and evening.127 Most studies report daily amplitudes of 15 30%, although the
most pronounced diurnal changes have been communicated for CTX (Figure 8).128134 It
should be borne in mind that the slope of diurnal changes is steepest during the morning
hours, which is usually the time at which urine samples are collected. This is true for
both urinary and serum markers. Controlling the timing of sample collection is therefore
a bare necessity for all types of markers (see also further below).
Circadian rhythm in bone metabolism causes markers to vary by 10-20%. A study by Yavropoulou et
al investigated postprandial suppression of bone resorption, which is one of the main contributors to
the circadian rhythm of bone turnover markers. The study concluded that the physiologic response to
nutrients in terms of the general homeostasis and functional integrity of the skeleton is important, as
evidenced by the preservation and augmentation of postprandial suppresion
hormone secretion.
SINGER FREDERICK R. AND EYRE DAVID R.. Using biochemical markers of bone
turnover in clinical practice. C L E V E L A N D C L I N I C J O U R N A L O F M E D I C I
NEVOLUME75NUMBER10OCTOBER2008