Arthritis Panel

Deoxypyridinoline (Dpd) Cross-links (Serial Monitor)

CPT Test code: 82523;82570

Test Includes: Long-term serial monitoring of results; color graphic summary report
Specimen: Urine
Volume: 10 mL
Minimum Volume: 1 mL
Container: Plastic urine container, no preservative
Special Instruction: The account must submit the patient’s Social Security number to monitor. Values obtained with different assay methods should not be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor each patient’s course of therapy.
Collection: Collection before 10 AM is recommended (eg, first morning void). Do not add preservative. Specimen should not be exposed to strong light and must reach the laboratory within 72 hours of collection.
Storage Instructions: Refrigerate
Temperature Period
Room temperature 14 days
Refrigerated 14 days
Frozen 14 days
Freeze/thaw cycles Stable x3
Cause for Rejections: Blood contamination
Cause for Rejections: Pediatric:1

• Prepubertal (Tanner Stage I): <41.8 nmol Dpd/mmol creatinine

• Pubertal (Tanner Stage II-IV): <83.5 nmol Dpd/mmol creatinine

Adults: 2.3-7.4 nmol Dpd/mmol creatinine

Use: The Dpd test can be used as a tool to assess bone resorption rates in healthy individuals and in patients with enhanced risk of developing metabolic bone disease. Significantly high levels of Dpd are found in children, in postmenopausal women due to estrogen deficiency, and in patients with diseases that have high bone turnover rates. Dpd can be used to monitor antiresorptive therapies in postmenopausal women and in individuals diagnosed with osteoporosis.
Limitations: This test has not been established to predict development of osteoporosis or future fracture risk.
Methodology: Immunochemiluminometric assay (ICMA)
Additional Information: Bone is constantly undergoing a process of remodeling that consists of degradation, or resorption, mediated by osteoclasts and rebuilding mediated by osteoblasts. This process is tightly coupled in individuals with healthy bone metabolism. In certain conditions, the rate of resorption exceeds the rate of rebuilding resulting in a net loss of bone. Deoxypyridinoline (Dpd) is a crosslink of type 1 collagen that provides tensile strength to the collagen matrix of bone. Dpd is released into circulation during bone resorption and is excreted unmetabolized into urine. Since Dpd levels are not affected by diet or physical exercise, urinary Dpd concentrations reflect the true rate of bone turnover.
Footnotes: 1. Conti A, Ferrero S, Giambona S, et al, “Urinary Free Deoxypyridinoline Levels During Childhood,” J Endocrinol Invest, 1998, 21(5):318-22.PubMed 9648054
References: Delmas PD, “Biochemical Markers for the Assessment of Bone Turnover,” Osteoporosis: Etiology, Diagnosis, and Management, 2nd ed, Riggs BL, Melton LJ III, eds, Philadelphia, PA: Lippincott-Raven, 1995, 319-33.

Miller PD, Baran DT, Bilezikian JP, et al, “Practical Clinical Application of Biochemical Markers of Bone Turnover: Consensus of an Expert Panel,” J Clin Densitom, 1999, 2(3):323-42 (review). PubMed 10548827

National Osteoporosis Foundation, Fast Facts on Osteoporosis, Washington, DC: National Osteoporosis Foundation, 1994.

National Osteoporosis Foundation, Fast Facts on Osteoporosis, Arthritis, and Osteoarthritis, Washington, DC: National Osteoporosis Foundation, 1991.

National Osteoporosis Foundation, The Older Person’s Guide to Osteoporosis, Washington, DC: National Osteoporosis Foundation, 1993.

Robins SP, Woitge H, Hesley R, et al, “Direct, Enzyme-Linked Immunoassay for Urinary Deoxypyridinoline As a Specific Marker for Measuring Bone Resorption,” J Bone Miner Res, 1994, 9(10)1643-9. PubMed 7817812

Rosen HN, Dresner-Pollak R, Moses AC, et al, “Specificity of Urinary Excretion of Cross-Linked N-Telopeptides of Type I Collagen As a Marker of Bone Turnover,” Calcif Tissue Int, 1994, 54(1):26-9. PubMed 8118749

Ross PD, Knowlton W, “Rapid Bone Loss Is Associated With Increased Levels of Biochemical Markers,” J Bone Miner Res, 1998, 13(5):297-302.PubMed 9495524