Deoxypyridinoline (Dpd) Cross-links (Serial Monitor)

CPT: 82523; 82570
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Test Includes

Long-term serial monitoring of results; color graphic summary report

Special Instructions

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.

Expected Turnaround Time

4 - 5 days

Related Documents

Specimen Requirements




10 mL

Minimum Volume

1 mL


Plastic urine container, no preservative


Collection before 10 AM is recommended (eg, first morning void). Do not add preservative.

Storage Instructions


Stability Requirements



Room temperature

14 days


14 days


14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Gross hemolysis; gross icterus

Test Details


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.


This test has not been established to predict development of osteoporosis or future fracture risk.


Immunochemiluminometric assay (ICMA)

Reference Interval

• Pediatric:1

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

− Pubertal (Tanner Stage II to IV): <83.5 nmol Dpd/mmol creatinine

• Adults: 2.3−7.4 nmol Dpd/mmol creatinine

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.


1. Conti A, Ferrero S, Giambona S, Sartorio A. Urinary free deoxypyridinoline levels during childhood. J Endocrinol Invest. 1998 May; 21(5):318-322. 9648054


Delmas PD. Biochemical markers for the assessment of bone turnover. In: Riggs BL, Melton LJ III, eds. Osteoporosis: Etiology, Diagnosis, and Management. 2nd ed. Philadelphia, Pa: Lippincott-Raven;1995:319-333.
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 Fall; 2(3):323-342 (review). 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, Ju J, Seyedin S, Seibel MJ. Direct, enzyme-linked immunoassay for urinary deoxypyridinoline as a specific marker for measuring bone resorption. J Bone Miner Res. 1994 Oct; 9(10)1643-1649. 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 Jan; 54(1):26-29. 8118749
Ross PD, Knowlton W. Rapid bone loss is associated with increased levels of biochemical markers. J Bone Miner Res. 1998 Feb; 13(2):297-302. 9495524


Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
511105 Deoxypyridinoline (Serial) 27424-1 511611 Deoxypyridinoline nmol/L 27424-1
511105 Deoxypyridinoline (Serial) 27424-1 013672 Creatinine, Urine mg/dL 2161-8
511105 Deoxypyridinoline (Serial) 27424-1 511612 DPD/Crt Ratio nmol/mmol cr 25095-1
511105 Deoxypyridinoline (Serial) 27424-1 511958 PDF 80563-0

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