Narong Bunyaratavej

Chulalongkorn University, Bangkok, Bangkok, Thailand

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Publications (28)0 Total impact

  • Narong Bunyaratavej
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    ABSTRACT: The present study aims to investigate a proper dose of alfacalcidol by using the parathyroid level as a marker due to the end product of alfacalcidol is calcitriol which has a property of suppression secretion of parathyroid glands. The research enrolled 259 volunteers which were divided into 2 groups. Each group took the elemental calcium 800 milligram plus alfacalcidol at the different doses. Group (A) received alfacalcidol 1.0 microgram/day and Group (B) had alfacalcidol 1.5 micrograms/day for 3 months. Group (A) could not suppress the secretion of PTH compared with Group (B) of which the PTH level was decreased significantly (p = 0.047). Alfacalcidol in both groups can not decrease the bone resorption monitored by using the bone resorption marker, BetacrossLaps or bCTx.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S7-9.
  • Narong Bunyaratavej, Shutipen Buranasinsup
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    ABSTRACT: The principle aim of the present study is to investigate the dark side of calcium, pollutions in calcium preparation especially lead (Pb), mercury (Hg) and cadmium (Cd). The collected samples were the different calcium salts in the market and 18 preparations which were classified into 3 groups: Calcium carbonate salts, Chelated calcium and natural-raw calcium. All samples were analyzed for lead, cadmium and mercury by inductively Coupled Plasma Mass Spectrometry (ICP-MS) technique, in house method based on AOAC (2005) 999.10 by ICP-MS. The calcium carbonate and the natural-raw calcium in every sample contained lead at 0.023-0.407 mg/kg of calcium powder. Meanwhile, the natural-raw calcium such as oyster, coral and animal bone showed amount of lead at 0.106-0.384 mg/kg with small amounts of mercury and cadmium. The chelated calcium such as calcium gluconate, calcium lactate and calcium citrate are free of lead.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S56-8.
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    ABSTRACT: The present study showed the correlation between undercarboxylated osteocalcin and vitamin D had a role in production of the undercarboxylated osteocalcin, when the amount of vitamin D 25 (OH) D, (below 30 ng/ml) was decreased, the linear correlation (r) between the vitamin D and undercarboxylated osteocalcin were also decreased r = 0.032 when the level of vitamin D was risen, the linear correlation was 0.274,unfortunately the study-population had little group of the normal level of vitamin D due to most of them were vitamin D insufficiency so the authors could not show the more value of 'r'. However, the present study confirmed that the role of vitamin D information of undercarboxylated osteocalcin (UcOC) which we recognized the UcOC at the low level of vitamin D will misinterpretation of the level of vitamin K2.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S87-9.
  • Narong Bunyaratavej
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    ABSTRACT: The present study showed the lowest values of bone markers from osteoblast, NMID osteocalcin, 10.81 +/- 3.9 ng/ ml and PINP 15.88 +/- 7.09 ng/ml at lowest level of osteoclast, betaCTx, 0.066 + 0.22 ng/ml should be the cut value for osteoblastic function. At this level betaCTx, had no correlation with PINP (r = 0.198, p = 0.003) or NMID osteocalcin (r = 0.035, p = 0.606) compared to the normal value of the control group and the correlation (r) between betaCTx and NMID osteocalcin, betaCTx and PINP, which were 0.757 and 0.752 (p = 0.001) respectively and recognized as normal bone turnover with coupling effect. So, bone markers of osteoblast at the lowest value of betaCTx (0.066 ng/ml) with NMID osteocalcin, 10.81 +/- 3.9 ng/ml and PINP 15.887.09 ng/ml may be the cut value of osteoblast reflecting poor functions. The benefit of identifying the cut values of osteoblast will help in making decisions in osteoporotic management.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S84-6.
  • Achariya Anek, Vijit Kanungsukasem, Narong Bunyaratavej
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    ABSTRACT: The purpose of this research is to develop a circuit box jumping exercise program and to examine the effects of the circuit box jumping exercise program on bone formation, bone resorption, health related to physical fitness and balance of the premenopausal females. The samples consisted of 57 female volunteers from Chulalongkorn University, aged between 35-45. The subjects were divided into two groups: 28 females in the experimental group and 29 females in the control group by the simple random sampling method. The experimental group participated in the circuit box jumping exercise program while wearing heart rate monitors. The exercise speed was determined by the rhythm of the music. The experimental group completed two circuits of jumping at 6 stations with 10 jumps per station three times per week, for a period of twelve weeks. Each jumping box at Station 1 and 4 was 10 cm. high; the boxes at Station 2 and 5 were 15 cm. high; and at Station 3 and 6, the boxes were 20 cm. in height. The intensity is 60%-80% of a maximum heart rate. The control group did not participate in the circuit box jumping exercise program. The collected data before and after the experiment were the results of the physiology test, the biochemical bone markers, the health related physical fitness and the balance ability. The collected data were compared and analyzed by the mean and standard deviation. The differences of the tests are statistically significant at the .05 level. The results of the present study are as follows; 1. After the 12-week experiment training, the findings indicated that the mean scores on bone resorption (beta-Crosslaps) of the experimental group and the control group were significantly different at 0.05 level. In addition, the findings showed that the percentage changes on bone resorption (beta-Crosslaps) variance of the experiment group reduced by -25.6528%, while that of the control group reduced by -0.5933%. Bone formation (PINP/beta-Crosslaps) in the circuit box jumping subjects was significantly higher after the training intervention (p < 0.05). 2. The general physiological data in the circuit box jumping subjects after the training intervention was significantly lower in weight, resting heart rate and systolic blood pressure (p < 0.05). 3. The health-related to physical fitness in the circuit box jumping subjects after the training intervention was significantly lower in waist/hip ratio, body fat and fat in percent while skeleton muscle mass, leg strength, flexibility and VO2max were significantly higher after the training intervention (p < 0.05). 4. The balance in the circuit box jumping subjects after the training intervention was significantly better after the training intervention (p < 0.05). The circuit box jumping training has the positive effects on slowing down the bone resorption and consequently the bone formation increased. It can be concluded that the circuit box jumping training reduces some risks of osteoporosis in the premenopausal women. Additionally, it promotes the better health-related to physical fitness and balance.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S17-23.
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    ABSTRACT: The bone remodeling process called osteoblasts has an important role in bone formation working together with osteoclasts of which the cells are responsible for bone resorption. In addition, these bone turnover markers are used to follow-up the conditions of bone remodeling in the patients. Recently, osteoblastic lineage cells have been found that they exist in the human peripheral blood. However there has been no report about the amount of circulating osteoblastic lineage cells that have the relationship with the samples of bone turnover markers showing the bone remodeling condition. In the present study, circulating osteoblasts were quantified in 43 subjects aged between 25-90 years. They were classified by age into 3 groups: A) lower than 60 years old (n = 9), B) from 60 to 79 years old (n = 22) and C) equal and over 80 years old (n = 12). All were studied by the flow cytometry method using an antibody to osteocalcin and bone turnover markers beta-CrossLab (betaCTx), PINP and NMID. These markers including parathyroid hormone were analyzed. The result showed the best positive correlation between the percentage of circulating osteoblasts and bone turnover markers of the equal and over 80-year-old group. While another result exhibited the negative correlation of circulating osteocalcin positive cells with the bone turnover markers in the group of lower than 60 years old. As circulating osteoblasts had the correlation with bone turnover markers in the group aged 80 years old, this could be used as the markers to follow up the bone turnover situation of the patients in this age group. However, this is a pilot study. Further analysis of more amounts of subjects should be done for a better result.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S71-5.
  • Narong Bunyaratavej, Shutipen Buranasinsup
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    ABSTRACT: This research studied the validity and correlation of beta-CTx (Betacrosslap) and Pyridinoline (PYD) in 71 cases of postmenopausal Thai women who attended at the osteoporosis clinic. The validity consisted of sensitivity, specificity and accuracy of PYD. They were 53.44, 84.6 and 59.15% respectively. So, the validity of pyridinoline test was rather poor and the correlation between betacrosslap and pyridinoline was weak (r = 0.123, p = 0.0001) which was not significant in practice. In conclusion, the pyridinoline test was not proper for bone resorption even pyridinoline was abundant in bone.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S76-8.
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    ABSTRACT: There are several circulating bone markers that are useful for physicians in determining the bone quality. The markers are composed of N-terminal propeptide of type I collagen (PINP) which determines the bone formation, undercarboxylated osteocalcin (UcOC) and N-mid fragment of osteocalcin (N-MID) which determines the bone remodeling, C-telopeptide of type I collagen (betaPCTx) or betacrosslap (betaCTx), pyridinoline (PYD) and deoxypyridinoline (DPD) which determines the bone resorption. The vitamin named vitamin D (VitD) also affects the bone property. However there is little information about the relationship of these biomarkers. In this experiment, the researchers investigated the correlation of the circulating biomarkers and found the correlations between UcOC and betaCTx (r = 0.471, p = 0.011), between UcOC and Vit D (r = 0.39, p = 0.04), between N-MID and PINP (r = 0.833, p = 0.000), between N-MID and PCTx (r = 0.641, p = 0.000) and lastly between PINP and betaCTx (r = 0.657, p = 0.000) in the male group whereas the correlations between UcOC and PYD (r = 0.318, p = 0.043), between UcOC and DPD (r = 0.551, p = 0.008), between N-MID and PINP (r = 0.721, p = 0.000), between N-MID and PCTx (r = 0.719, p = 0.000), between N-MID and PYD (r = 0.485, p = 0.001), between N-MID and Vit D (r = 0.347, p = 0.026), between PINP and JCTx (r = 0.632, p = 0.000), between PINP and PYD (r = 0.312, p = 0.047), between bCTx and PYD (r = 0.365, p = 0.019), between PYD and DPD (r = 0.567, p = 0.006) and lastly between PYD and Vit D (r = 0.409, p = 0.008) were found in the females. In addition, the new biomolecule named matrix Gla protein (MGP), a small protein produced by bone tissues was also investigated. The authors found the correlation between MGP and PYD (r = 0.468, p = 0.012) in the males and found the correlations between UcOC and MGP (r = 0.421, p = 0.006), between N-MID and MGP (r = 0.333, p = 0.033), between MGP and PYD (r = 0.471, p = 0.002), between MGP and DPD (r = 0.472, p = 0.026) in the female group.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S90-5.
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    ABSTRACT: Parathyroid hormone (PTH), a new effective treatment for osteoporosis patients which promotes the anabolic effect in vivo, can enhance the differentiation of osteoblasts derived from the human skin-derived precursor cells (hSKPs) in vitro culture. This research investigated the effects of PTH by studying the gene expressions and other markers of osteoblast differentiation along with the induction of hSKPs to osteoblast in two experiment groups, i.e. the osteogenic induction medium (OM) only and the OM plus PTH (OM + PTH). The results of each type were compared between these two groups. Both groups expressed the Cbfa1 gene, a regulator of osteoblasts and also one of the most osteoblast specific genes. The findings were that the OM + PTH group showed more intense alkaline phosphatase staining than the other. The gene expressions of protein showing the mature osteoblasts like osteocalcin (OCN) and bone sialoprotein (BSP) in the OM + PTH group expressed higher and faster (Day 14) than the OM group. Moreover, the gene expression of osteoprotegerin (OPG) possessing the protein produced by the mature osteoblasts showed a higher level in the OM + PTH group on the same day as OCN and BSP occurred. This protein performs a function in inhibiting osteoclast maturation. The present study found that PTH enhanced the differentiation of osteoblasts derived from hSKPs by promoting the maturation of osteoblasts in vitro. It possibly concerns with the anabolic effect of PTH in a treatment for osteoporosis patients. Additionally, hSKPs are the interesting sources for osteoporosis treatments when combining with PTH.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S1-6.
  • Narong Bunyaratavej
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    ABSTRACT: The present study aimed to show whether the Strontium ranelate was the dual action possessing either antiresorptive or formative properties. This retrograded study included 56 postmenopausal women using the biological bone turnover markers as an evaluation. The antiresorptive property described by the mean value of Beta-crossLap or bCTx before taking 2 grams of Strontium ranelate per day was 0.377 ng/ml compared with the mean of CTx after the 3-month treatment which was 0.409 (p = 0.083) ng/ml. The result indicated that this agent could not suppress the bone resorption, otherwise Strontium ranelate was not able to control the progress of bone resorption. It was found that 67.92 per cent showed the uncontrollable resorption. In addition, the bone formation monitored by PINP was diminished 34.54% and only 60% of the bone formation values was little increased but still below normal (44.5 ng/ml) while 1.8% was no response. The present study displayed that the Strontium ranelate was neither antiresorptive nor formative actions and it was certainly not a dual action via the method of biological bone turnover markers.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S35-7.
  • Narong Bunyaratavej
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    ABSTRACT: This clinical study aimed to provide awareness of the teriparatide injection and also prevention of unwanted events. The 72 cases aged between 52-69 with the inclusion criteria: back pain proved by the x-ray with one or more collapsed spines, no underlying diseases and no history of bone tumor, hyperparathyroid, hypercalcemia. The blood screening for renal, liver profiles, uric acid, mineral profile and bone turnover markers (bCTx, PINP) are used as 6-month monitor. The results showed that the common unwanted effects were hypercalcemia, hyperuricemia, hypomagnesia: 5.5%, 54.56% and 43% respectively at the first month of the therapy. At the end of 6th month, these conditions occurred 1.38%, 8.77% and 5.5% respectively. The bone turnover markers, PINP, was a quick response in the first month, the PINP was double increased then triple increased at the end of the 6th month (p = 0.001). Teriparatide did not disturb the activity of parathyroid glands because the PTH was within the normal limit during the treatment (p = 0.001). The blood screening monitor was useful for preventing the unwanted effects and the bone turnover markers, PINP was beneficial for evaluation of Teriparatide efficacy in short outcomes leading to physicians and patients' confidence.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S31-4.
  • Narong Bunyaratavej
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    ABSTRACT: The present study of the bone markers in the healthy Thai females and males enrolled 588 females and 53 males with age range from 25 to 42 years. The potential modification of variations was controlled. The bone resorptive markers, betaCTx, of females and males were 0.3 +/- 0.169, 0.412 +/- 0.191 ng/ml respectively. The bone formation markers, PINP, of females and males were 44.5 +/- 19.92, 58.1 +/- 37.7 ng/ml respectively. These markers could be recognized as the standard values for comparison.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S47-9.
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    ABSTRACT: Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and micro-architectural deterioration of the bone tissues resulting in bone fragility and susceptibility to fracture. It is caused by the decrease of bone formation and the increase of bone resorption. Both bone formation and resorption can be examined by the circulating biomolecules. The biomolecules using in determining the bone formation are composed of osteocalcin (OC) in form of N-terminal midmolecule fragment (N-MID) and undercarboxylated osteocalcin (UcOC). The other bone formation markers are matrix Gla protein (MGP) and N-terminal propeptide of Type I collagen (PINP) whereas the biomolecules using in determining the bone resorption comprises of C-terminal cross-linking telopeptide of Type I collagen (betaCTx), collagen cross-links molecules which are pyridinoline (PYD) and deoxypyridinoline (DPD). Nevertheless, some vitamins such as vitamin D (Vit D) and some hormones e.g. parathyroid hormone (PTH) are also affected to the bone quality. To monitor and assess the bone mass, the normal values of bone markers as well as the relevant biomolecules are important and should be established. The researchers aimed to investigate the normal values of the interesting bone biomarkers and the relevant biomolecules in the adult volunteers.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2011; 94 Suppl 5:S96-101.
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    ABSTRACT: The undercarboxylated osteocalcin (ucOC) level is increased in the elderly and postmenopausal women compared with the young, healthy, and reproductive women. The high level of serum UcOC reflects the vitamin K2 deficiency which not only results in high skeletal turnover, low bone quality, and low bone density, but also increases a risk of fracture. The objective of the study is to measure the ucOC level, the 25-hydroxy vitamin D (25(OH)D) levels, and the prevalence of vitamin K2 and vitamin D deficiency in Thai female patients with hip fracture. The serum UcOC and 25(OH)D levels of the 40 female patients with hip fracture (the mean age 77.2 +/- 9.7 years) were measured and compared to the control group of the 47 randomly selected female volunteers (the mean age 75.2 +/- 8.1 years) without osteoporosis-related problems. The serum level of UcOC (median) in the female patients with hip fracture was significantly higher than the control group (p = 0.0001). Fifty-three percent had the serum UcOC level above the cut-off point at 2.314 ng/ml and 83% had lower serum 25(OH)D than the cut-off point at 30 ng/ml. The serum UcOC levels; however, were not correlated with 25(OH)D levels (r = 0.191, p = 0.237). The high prevalence of vitamin K2 and vitamin D deficiency was found in the Thai female patients with hip fracture. The additional treatment with vitamin K2 supplement besides calcium and vitamin D is a beneficial effect for osteoporosis.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 09/2009; 92 Suppl5:S7-11.
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    ABSTRACT: Vitamin D insufficiency of Thai elderly women in urban area were higher than in rural area because of the difference in life style. Until now there are no any evidences about vitamin D status in Thai premenopausal women. This study was the multicenters study from 5 provinces of Thailand which cover all region of Thailand except southern area. The mean (SE) of calcidiol level of Thai premenopausal women was 29.09 (0.42) ng/ml, and with the cut point of < or = 35 ng/ml; the prevalence of vitamin D insufficiency was 77.81%. Chiang Mai had lowest calcidiol level (25.09 ng/ml) and had highest PTH, and bone resorption markers. The prevalence of vitamin D insufficiency was highest in Khon Kaen (88.78%) and Chiang Mai (84.62%) province respectively. Life style modification to expose more sunlight should be advised for increasing the serum vitamin D and lowering the risk of osteoporosis.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 09/2009; 92 Suppl5:S17-20.
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    ABSTRACT: The recommended dose of Menatretenone is 45 mg three times a day; however the compliant in daily practice is not convenient. This study shows the twice dose per day is inferior to the recommended dose. This study used the level of Gla protein in osteocalcin as a parameter for the comparison. The mean of three-time dose a day is 11.27 nanogram per milliliter while the mean of the other group is 6.07 nanogram per milliliter after the three-month treatment.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 09/2009; 92 Suppl5:S4-6.
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    ABSTRACT: A comparison study of bone turnover between the diabetic type 2 and the non-diabetic patients was conducted by using the age matching technique. The bone markers of the diabetic type 2 patients showed CTx = 0.48 ng/ml, NMID osteocalcin = 24.62 ng/ml and PINP = 38.61 ng/ml. All study parameters of bone markers were higher than the control group. Thus, the diabetic cases with high bone turnover assuredly predisposed to osteoporosis. The bone change consistently monitored particularly in the diabetic cases could prevent osteoporosis. The high calcium diets and regular exercises were recommended for the diabetic patients.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 09/2009; 92 Suppl5:S45-8.
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    ABSTRACT: This survey of osteoporotic opinion was conducted to 150 Thai physicians in every part of the country with 10 questionnaires. The details of the questions concentrated on the osteoporosis in the aspects of diagnosis, management, methods of assessment, common medicine for treatment. The most responder specialty was Orthopedist (79%), others were Gynecologist (3%), Rheumatologist (5%), Internist (5%), the others (7%) respectively. The diagnosis of osteoporosis used Dual-energy X-ray absorptiometry (DXA), (81%) in the case of this equipment as well as other methods (16%) are available. The per cent of other methods are X-ray, clinical symptoms, microdensitometry, QUS, biochemical bone markers and others: 30, 23, 13, 5, 3 and 6 respectively. About twenty-five percent of physicians took responses to 21-100 cases per month while two per cent of responders had more than 100 cases per month. The most common three ranking kinds of criteria were used for initiating medication for the treatment of osteoporosis that had low bone mineral density, signs of vertebral fracture, and menopause which they considered as the importance of prophylactic medication for patients. The continuation of medication depends on the following factors: experience of serious side effect (62%), affordable expense (53%) and stable bone mass (52%). The desirable features of anti-osteoporosis agents are stopped fracture, increasing BMD, cost effectiveness, side effect, stopped bone resorption, pain relieve and drug compliance respectively. Calcium is most commonly prescribed on condition that premenopausal and postmenopausal women have without fracture or with fracture: patients are elderly and treated with the prolonged steroid application. Bisphosphonates are widely used in case of fracture in every group. Alfacalcidol, vitamin D analog is the third prescription in the above conditions. Bisphosphonate, Calcium and Alfacacidol are the common kinds of combination under the above conditions. In addition, these kinds of drugs are commonly used for continuation after the remission therapy.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 09/2009; 92 Suppl5:S54-9.
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    ABSTRACT: This study involved 78 participants taking 150 mg of Ibandronate once a month for the investigation of the drug efficacy and safety. Ibandronate had a strong antiresorptive action that decreased 67.9 per cent of bone resorption. The total cases of unwanted effect were 21 that showed the common adverse events like other bisphosphonate. The most common events were flu-like symptom (8.75%) and dyspepsia (7.5%) which occurred at the first tablet. Most participants subsided after the following months, but only one case persisted in these symptoms through the study period while the others had a myalgia, diarrhea and burning of epigastric in percent of 6.25, 2.5, 1.25 respectively. Ibandronate (150 mg) showed the strong antiresorptive effect and good compliance for taking once a month.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 09/2009; 92 Suppl5:S72-5.
  • Narong Bunyaratavej
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    ABSTRACT: The biochemical bone markers are the firmly approved means for bone assessment with high accuracy for detecting the status of bone functions in real time. The values obtained from the bone markers are continuously fluctuating. The interpretation, thus, needs to be based on the controlled clinical criteria such as fasting blood venous puncture required at 8:00-9:00, gender age and information of previously medicated treatments. These characteristic values are compared with the normal ones derived by the healthy young adult persons. The bone markers are essentially requested when diagnosing the bone state. Both formation and resorption markers represent bone turnover. The low values of bone markers are the signs of being low bone turnover as well as the high values show high bone turnover. The bone markers strongly support the diagnosis of bone metabolism, bone diseases and the evaluation of medication and bone metastasis.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet 09/2009; 92 Suppl5:S116-20.

Publication Stats

68 Citations

Institutions

  • 2011
    • Chulalongkorn University
      • Faculty of Sports Science
      Bangkok, Bangkok, Thailand
  • 2005–2011
    • Mahidol University
      • • Faculty of Veterinary Science
      • • Department of Orthopedic Surgery (Siriraj)
      Bangkok, Bangkok, Thailand
    • Khon Kaen University
      • Department of Orthopaedics
      Khon Kaen, Changwat Khon Kaen, Thailand
  • 2009
    • Thammasat University
      • Department of Orthopaedics
      Bangkok, Bangkok, Thailand