Hydroxyproline is a collagen related amino acid. Hydroxyproline is a nonessential amino acid, which means that it is manufactured from other amino acids in the liver. Hydroxyproline is necessary for the construction of the body’s major structural protein, collagen. Hydroxyproline is present in essentially all tissues and all genetic types of collagen. 
Defects in collagen synthesis lead to easy bruising, internal bleeding, breakdown of connective tissue of the ligaments and tendons, and increased risk to blood vessel damage.
Hydroxyproline’s immediate precursor is proline. The conversion of proline to hydroxyproline requires vitamin C (ascorbic acid). Vitamin C deficiency results in the poor conversion of proline to hydroxyproline.
Collagen synthesis requires iron, alpha-ketoglutarate and vitamin C. Chondroitin sulfate and manganese can also be helpful.
- Elevated urinary hydroxyproline is a reflection of bone lysis and may also occur in RA, hyperparathyroidism, and OM; 
- Increased serum and urine levels of hydroxyproline have been demonstrated in Paget’s disease 
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