title: Laboratory reproducibility of biochemical markers of bone turnover in clinical practice.
abstract: CONCLUSIONS
  To determine the laboratory reproducibility of urine N-telopeptide and serum bone-specific alkaline phosphatase measurements, we sent identical specimens to six US commercial labs over an 8-month period. Longitudinal and within-run laboratory reproducibility varied substantially. Efforts to improve the reproducibility of these tests are needed.
  
  
  BACKGROUND
  We assessed the laboratory reproducibility of urine N-telopeptide (NTX) and serum bone-specific alkaline phosphatase (BAP).
  
  
  METHODS
  Serum and urine were collected from five postmenopausal women, pooled, divided into identical aliquots, and frozen. To evaluate longitudinal reproducibility, identical specimens were sent to six US commercial labs on five dates over an 8-month period. To evaluate within-run reproducibility, on the fifth date, each lab was sent five identical specimens. Labs were unaware of the investigation.
  
  
  RESULTS
  Longitudinal coefficients of variation (CVs) ranged from 5.4% to 37.6% for NTX and from 3.1% to 23.6% for BAP. Within-run CVs ranged from 1.5% to 17.2% for NTX. Compared to the Osteomark NTX assay, the Vitros ECi NTX assay had significantly higher longitudinal reproducibility (mean CV 7.2% vs. 30.3%, p < 0.0005) and within-run reproducibility (mean CV 3.5% vs. 12.7%, p < 0.0005).
  
  
  CONCLUSIONS
  Reproducibility of urine NTX and serum BAP varies substantially across US labs.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA. anne.schafer@ucsf.edu
authors.forename: A L
authors.initials: AL
authors.lastname: Schafer
authors.forename: E
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: R
authors.initials: R
authors.lastname: Ramachandran
authors.forename: N
authors.initials: N
authors.lastname: Mahmoudi
authors.forename: D C
authors.initials: DC
authors.lastname: Bauer
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016723:Bone Remodeling / Q000502:physiology*; D019411:Clinical Laboratory Techniques / Q000592:standards; D024042:Collagen Type I / Q000652:urine*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010455:Peptides / Q000652:urine*; D017698:Postmenopause / Q000097:blood / Q000652:urine; D012016:Reference Values; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D000469:Alkaline Phosphatase