This chapter explains normal bone and calcium metabolism and provides an overview of related disorders, including: hypercalcemia, hyperparathyroidism, hypoparathyroidism, hypocalcemia, vitamin D intoxication, vitamin D deficiency, rickets, osteomalacia and osteoporosis. For each immunoassay analyte of interest in this field the biological function is explained, with the clinical applications of the test and its limitations. Typical assay technology is described. The type of sample and frequency of use are included, with an example reference interval (for background information only). The analytes included are 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone, PTH-related protein, calcitonin, alkaline phosphatase, osteocalcin, procollagen I extension peptides, pyridinoline, deoxypyridinoline, pyridinium cross-linked carboxy-terminal telopeptides and serum tartrate-resistant acid phosphatase. In the final section, there is a summary of bone marker limitations and a tabulated summary of changes in ions, hormones, and bone markers in conditions associated with abnormal calcium and bone metabolism.

Professor Bill Fraser was born and educated in Glasgow, graduating from Glasgow University with BSc (Hons) MBChB and MD (Hons). He trained in Glasgow’s teaching hospitals before spending time as a consultant/travelling fellow in Canada. In 1991 he was appointed Senior Lecturer in Chemical Pathology and Head of the Metabolic Bone Disease Unit at the Royal Liverpool University Hospital, promoted to Reader in 1998, Professor in 2001, Head of the Unit of Clinical Chemistry in 2008, and Head of Department of Musculoskeletal Biology in 2010. He was Director of the Masters in Research for Clinical Science from August 2008. He was appointed Professor of Medicine at Norwich Medical School, University of East Anglia in May 2011. He supervises an active research group investigating the diagnosis and treatment of metabolic bone disease including osteoporosis, Paget’s Disease of Bone, osteomalacia and rare bone disease. He is on the Editorial Board of several journals, a Director of the Supra Regional Assay Service for bone metabolism and calcium homeostasis, and a Medical Advisor to the National Osteoporosis Society. He was a recent recipient of the ACB Foundation Award and presenter of the John Ireland Lecture.

This chapter also contains material contributed to previous editions by Kay W. Colston and JohnC. Stevenson from previous editions.

Bone, calcium, phosphate, calcium-sensing receptor, bone, mineral density, hypercalcemia, hyperparathyroidism, hypoparathyroidism, hypocalcemia, vitamin D intoxication, vitamin D deficiency, rickets, osteomalacia, osteoporosis, Paget’s disease, parathyroid hormone, vitamin D, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, PTH-related protein, calcitonin, alkaline phosphatase, osteocalcin, procollagen, procollagen I extension peptides, collagen, collagen cross-link molecules, pyridinoline, deoxypyridinoline, pyridinium cross-linked carboxy-terminal telopeptides, serum tartrate-resistant acid phosphatase.