Deoxypyridinoline (Dpd) Cross-links (Serial Monitor)

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Turnaround Time: 2 - 5 days
CPT Code:

82523, 82570

Test Type: 10 mL Urine
Stability Time:



Room temperature

14 days


14 days


14 days

Freeze/thaw cycles

Stable x3

Reference Range:

• 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


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.

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. PubMed 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). 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, 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. 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 Jan; 54(1):26-29. PubMed 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. PubMed 9495524

Collection Details:

Collection 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.

Plastic urine container, no preservative.

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