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There is a limited role for [[Laboratory techniques|laboratory tests]] in the diagnosis of [[osteoporosis]]; however, they may be used for differentiating primary versus secondary causes of the disease.  
There is a limited role for [[Laboratory techniques|laboratory tests]] in the diagnosis of [[osteoporosis]]; however, they may be used for differentiating primary versus secondary causes of the disease.  


<br><span style="font-size:85%">'''Abbreviations:'''
=== Electrolyte and Biomarker Studies ===
'''HGB:''' Hemoglobin, '''WBC:''' White blood cell, '''RBC:''' Red blood cell, '''IgM:''' Immunoglobulin M type
<br><span style="font-size:85%">Abbreviations:</span>
</span><small><small>
 
{| border="1" cellpadding="2" style="text-align: center;"
<span style="font-size:85%">HGB: Hemoglobin</span>
 
<span style="font-size:85%">WBC: White blood cell</span>
 
<span style="font-size:85%">RBC: Red blood cell</span>
 
<span style="font-size:85%">IgM: Immunoglobulin M type</span><blockquote></blockquote>
{| style="text-align: center;" cellpadding="2" border="1"
|- style="background:LightGrey"
|- style="background:LightGrey"
! rowspan="2" |Disease  
! rowspan="2" |Disease  
Line 435: Line 442:
| -
| -
|  Positive
|  Positive
|}</small></small>
|}</small></small>
=== Electrolyte and Biomarker Studies ===
 
==== Complete blood count (CBC) ====
* Reduced [[hemoglobin]] level may reveal [[sickle cell anemia]], [[multiple myeloma]], or [[alcoholism]] associated osteoporosis.
* Elevated [[White blood cells|WBC]] count may reveal [[leukemia]]/[[lymphoma]] associated [[osteoporosis]].
* Reduced number of all cell types ([[RBC]], [[WBC]], and [[platelet]]) may reveal [[aplasia]] associated osteoporosis.


==== Serum calcium level and/or 24-hr serum calcium ====
===Bone turnover markers===
* Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] associated osteoporosis.
When [[Bone mineral density|bone mineral density (BMD)]] measurements do not provide a clear answer, [[bone turnover]] markers can be used in selected cases to assess the [[fracture]] risk. The combined use of [[Bone mineral density|BMD]] measurements and [[bone]] markers is likely to improve the assessment. [[Bone]] turnover markers are not routinely employed in diagnosing [[osteoporosis]]. [[Bone]] markers have two different types:
* [[Hypocalcemia]] may reflect [[vitamin D deficiency]] associated [[osteoporosis]].
* Bone formation markers


==== Serum phosphate level ====
* Bone resorption markers
* Reduced serum [[phosphate]] level may reveal [[hypophosphatemic rickets]] associated [[osteoporosis]].
{| cellpadding="2" border="1" align="center"
 
* Elevated serum [[phosphate]] level may reveal [[vitamin D deficiency]], or [[chronic kidney disease]] associated [[osteoporosis]].
 
==== Serum alkaline phosphatase level ====
* Elevated serum [[alkaline phosphatase]] level may reveal [[postmenopausal]] or destructive [[bone]] [[diseases]] (e.g., [[bone tumors]]) associated [[osteoporosis]].
 
==== Serum 25-(OH)-vitamin D level ====
* A reduced serum [[Vitamin D|25-(OH)-vitamin D]] level may reveal [[vitamin D deficiency]] associated [[osteoporosis]].
 
==== Serum creatinine level ====
* Elevated serum [[creatinine]] level may reflect [[chronic renal failure]], which leads to [[renal osteodystrophy]].
 
==== Serum magnesium level ====
* Reduced [[magnesium]] level may reflect [[vitamin D deficiency]] associated [[osteoporosis]].
 
==== Serum iron and ferritin levels ====
* Elevated [[iron]] and [[ferritin]] serum levels may reveal [[hemochromatosis]] associated [[osteoporosis]].
 
====Liver function tests (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and bilirubin)====
* An elevated level of [[liver function tests]] may reflect [[liver diseases]] (e.g., [[alcoholism]]) associated [[osteoporosis]].
 
==== Thyroid function tests ====
* Reduced [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]] and elevated [[Thyroxin|free thyroxine (T4)]] may reveal [[hyperthyroidism]] associated [[osteoporosis]].
 
==== Serum parathyroid hormone (PTH) level ====
* Elevated serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level may reflect [[hyperparathyroidism]] associated [[osteoporosis]].
 
* Reduced serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level may reveal decreased [[bone]] turnover and also increased [[Bone mineral density|BMD]], but abnormal [[bone]] microstructure and dynamic skeletal indices. The indices (i.e., mineralizing surface (MS) and bone formation rate (BFR)) are decreased in [[hypoparathyroidism]]; make them prone to [[osteopenia]].<ref name="pmid20485912">{{cite journal| author=Rubin MR, Bilezikian JP| title=Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement. | journal=Arq Bras Endocrinol Metabol | year= 2010 | volume= 54 | issue= 2 | pages= 220-6 | pmid=20485912 | doi= | pmc=3702727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20485912  }}</ref>
 
==== Testosterone and gonadotropin levels ====
* Reduced [[testosterone]] and [[gonadotropin]] levels in men may reveal [[hypogonadism]] associated [[osteoporosis]].
 
==== Urine free cortisol level ====
* Elevated urine free [[cortisol]] level may reflect [[Cushing's syndrome|hypercortisolism (Cushing's syndrome)]] associated [[osteoporosis]].
 
==== Other bio-markers tests ====
* [[Dexamethasone suppression test|Over night dexamethasone suppression test]] (for identifying [[cushing's syndrome]] associated [[osteoporosis]]).
 
* [[Serum protein electrophoresis]] (SPEP) and urine [[protein electrophoresis]] (for identifying [[multiple myeloma]] associated [[osteoporosis]]).
 
* [[Anti-gliadin antibodies|Anti-gliadin]] and anti-endomysial antibodies (for identifying [[celiac disease]] associated [[osteoporosis]]).
 
* Serum [[tryptase]] and urine N-methylhistamine (for identifying [[mastocytosis]] associated [[osteoporosis]]).
{| border="1" cellpadding="2" align="center"
! style="background:#efefef;" |Group
! style="background:#efefef;" |Group
! style="background:#efefef;" |Test
! style="background:#efefef;" |Test
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* Decreasing [[fracture]] risk
* Decreasing [[fracture]] risk
|}
|}
=== Bone turnover markers ===
When [[Bone mineral density|bone mineral density (BMD)]] measurements do not provide a clear answer, [[bone turnover]] markers can be used in selected cases to assess the [[fracture]] risk. The combined use of [[Bone mineral density|BMD]] measurements and [[bone]] markers is likely to improve the assessment. [[Bone]] turnover markers are not routinely employed in diagnosing [[osteoporosis]]. [[Bone]] markers have two different types:
===== Bone formation markers =====
* Serum [[osteocalcin]]: Elevated serum [[osteocalcin]] level in [[postmenopausal]] women reveal primary [[osteoporosis]], also lower [[Bone mineral density|BMD]] in [[femoral neck]] and [[lumbar vertebrae]]<ref name="pmid26436008">{{cite journal| author=Singh S, Kumar D, Lal AK| title=Serum Osteocalcin as a Diagnostic Biomarker for Primary Osteoporosis in Women. | journal=J Clin Diagn Res | year= 2015 | volume= 9 | issue= 8 | pages= RC04-7 | pmid=26436008 | doi=10.7860/JCDR/2015/14857.6318 | pmc=4576601 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26436008  }}</ref>
* Serum bone–specific [[alkaline phosphatase]]: 30 percent reduction may reflect treatment efficacy, increasing [[Bone mineral density|bone mineral density (BMD)]] and decreasing [[fracture]] risk<ref name="pmid15231011">{{cite journal |vauthors=Bauer DC, Black DM, Garnero P, Hochberg M, Ott S, Orloff J, Thompson DE, Ewing SK, Delmas PD |title=Change in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: the fracture intervention trial |journal=J. Bone Miner. Res. |volume=19 |issue=8 |pages=1250–8 |year=2004 |pmid=15231011 |doi=10.1359/JBMR.040512 |url=}}</ref>
* Serum type 1 [[procollagen]]: 30 percent reduction may reflect treatment efficacy, increasing [[Bone mineral density|BMD]] and decreasing [[fracture]] risk<ref name="pmid15231011" />
===== Bone resorption markers =====
* Urinary [[hydroxyproline]]: Elevated level is consistent with [[menopause]], therefore, [[hydroxyproline]]/[[osteocalcin]] ratio is favored for both evaluation and also monitoring of [[postmenopausal]] [[osteoporosis]]<ref name="pmid2099937">{{cite journal |vauthors=Gnudi S, Ripamonti C, Bonini AM, Pratelli L, Figus E |title=The importance of urinary hydroxyproline and serumal osteocalcin in the evaluation of post-menopausal osteoporosis |journal=Ital J Orthop Traumatol |volume=16 |issue=4 |pages=551–7 |year=1990 |pmid=2099937 |doi= |url=}}</ref>
* Urinary total pyridinoline (PYD): Elevated level may reflect higher bone resorption in [[postmenopausal]] female with [[lumbar spine]] [[osteoporosis]]<ref name="pmid1887826">{{cite journal| author=Delmas PD, Schlemmer A, Gineyts E, Riis B, Christiansen C| title=Urinary excretion of pyridinoline crosslinks correlates with bone turnover measured on iliac crest biopsy in patients with vertebral osteoporosis. | journal=J Bone Miner Res | year= 1991 | volume= 6 | issue= 6 | pages= 639-44 | pmid=1887826 | doi=10.1002/jbmr.5650060615 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1887826  }}</ref>
* Urinary free deoxypyridinoline (DPD): Elevated levels in [[postmenopausal]] female correspond with [[osteoporosis]] and higher [[hip]] [[fracture]] risk<ref name="pmid8889854">{{cite journal |vauthors=Garnero P, Hausherr E, Chapuy MC, Marcelli C, Grandjean H, Muller C, Cormier C, Bréart G, Meunier PJ, Delmas PD |title=Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study |journal=J. Bone Miner. Res. |volume=11 |issue=10 |pages=1531–8 |year=1996 |pmid=8889854 |doi=10.1002/jbmr.5650111021 |url=}}</ref>
* [[Tartrate resistant acid phosphatase|Tartrate-resistant acid phosphatase 5b]]: Elevated levels may reflect more severe [[osteoporosis]] in [[hip]]<ref name="pmid19453262">{{cite journal |vauthors=Bauer DC, Garnero P, Harrison SL, Cauley JA, Eastell R, Ensrud KE, Orwoll E |title=Biochemical markers of bone turnover, hip bone loss, and fracture in older men: the MrOS study |journal=J. Bone Miner. Res. |volume=24 |issue=12 |pages=2032–8 |year=2009 |pmid=19453262 |doi=10.1359/jbmr.090526 |url=}}</ref>
*[[Bone sialoprotein]] (BSP): Reduced levels after antiresorptive medicines reflect the decrease in [[Bone loss|bone mass loss]] and improving [[lumbar vertebrae]] [[Bone mineral density|BMD]]<ref name="pmid11763409">{{cite journal |vauthors=Shaarawy M, Hasan M |title=Serum bone sialoprotein: a marker of bone resorption in postmenopausal osteoporosis |journal=Scand. J. Clin. Lab. Invest. |volume=61 |issue=7 |pages=513–21 |year=2001 |pmid=11763409 |doi= |url=}}</ref>
*Urinary [[collagen]] type 1 cross-linked N-telopeptide (NTX): Reduced level to half of the original measure may reveal increase in [[Bone mineral density|BMD]] and decrease in [[fracture]] risk<ref name="pmid12817758">{{cite journal |vauthors=Eastell R, Barton I, Hannon RA, Chines A, Garnero P, Delmas PD |title=Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate |journal=J. Bone Miner. Res. |volume=18 |issue=6 |pages=1051–6 |year=2003 |pmid=12817758 |doi=10.1359/jbmr.2003.18.6.1051 |url=}}</ref>
* Serum [[collagen]] type 1 cross-linked C-telopeptide (CTX): Reduced level of 30 percent may reflect treatment efficacy, increasing [[Bone mineral density|bone mineral density (BMD)]] and decreasing [[fracture]] risk<ref name="pmid15231011" />
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
​​
[[Category:Primary care]]

Latest revision as of 23:28, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

There is a limited role for laboratory tests in the diagnosis of osteoporosis; however, they may be used for differentiating primary versus secondary causes of the disease. Laboratory tests for the diagnosis of osteoporosis include some baseline tests like complete blood count (CBC), serum calcium, phosphate, alkaline phosphatase, and 25-(OH)-vitamin D. There are tests for diagnosing secondary osteoporosis, which include but not limited to 24 hr serum calcium, serum protein electrophoresis, and serum thyroid hormones.

Laboratory findings

There is a limited role for laboratory tests in the diagnosis of osteoporosis; however, they may be used for differentiating primary versus secondary causes of the disease.

Electrolyte and Biomarker Studies


Abbreviations:

HGB: Hemoglobin

WBC: White blood cell

RBC: Red blood cell

IgM: Immunoglobulin M type

Disease Electrolyte and Bio-marker Studies
Complete blood count (CBC) Serum calcium level 24-hr serum calcium Serum phosphate level Serum alkaline phosphatase level Serum 25-(OH)-vitamin D level Serum magnesium level Serum creatinine level Serum iron and ferritin level Liver function tests Thyroid function tests Serum parathyroid hormone (PTH) level Serum Testosterone/gonadotropin level Urine free cortisol level Over night dexamethasone suppression test Serum protein electrophoresis/ Urine protein electrophoresis Anti-gliadin
Anti-endomysial antibodies 		Serum tryptase
Urine N-methylhistamine
Postmenopausal osteoporosis - - - - ↑ - - - - - - - - - - - - -
Vitamin D deficiency - ↓ ↓ ↓ ↑ ↓ ↓ - - - - ↓ - - - - - -
Sickle cell anemia ↓HGB - - - ↑ - - - ↓ ↑ - - - - - - - -
Multiple myeloma ↓HGB ↑ ↑ ↑ ↑ - - ↑ ↓ - - - - - - ↑ IgM - -
Leukemia/lymphoma ↑WBC ↑ - - - - - - - - - - - - - - - -
Alcoholism ↓HGB - - - - - - - ↓ ↑ - - - - - - - -
Aplasia ↓RBC, ↓WBC, ↓PLT - - - - - - - ↓ ↑ - - - - - - - -
Malignancy - ↑↑↑ ↑↑↑ ↑ ↑ - - ↑ - ↑ - - - - - - - -
Hypophosphatemic rickets - ↓↓ ↓ ↓ ↑ ↓↓ ↓ - - - - - - - - - - -
Chronic kidney disease ↓HGB ↑↑ ↑↑ ↓↓ - ↓ ↑ ↑↑↑ ↓ - - - - - - ↑ Urine protein - -
Destructive bone diseases (e.g., bone tumors) - ↑↑ ↑↑ ↑ ↑↑↑ - - ↓ - - - - - - - - - -
Liver diseases ↓HGB - - - - - - - - ↑↑ - - - - - - - -
Hemochromatosis ↑HCT - - - - - - ↑ ↑↑↑ ↑ - - - - - - - -
Hyperthyroidism - - ↑ ↑ - - - - - - ↑↑ - - - - - - -
Hypoparathyroidism - ↓ ↓ ↑ ↓ - ↓ - - - - ↓↓ - - - - - -
Hyperparathyroidism - ↑ ↑ ↓ ↑ - ↑ - - - - ↑↑ - - - - - -
Hypogonadism ↓HGB - ↓ ↓ - - - - - - - - ↓↓ - - - - -
Hypercortisolism (Cushing's syndrome) - - - - - - - - - - - - - ↑↑ not suppresed - - -
Celiac disease ↓HGB ↓ ↓ ↓ ↑ ↓ ↓ ↓ ↓↓ - ↓ - - - - ↓ Plasma protein Positive -
Mastocytosis ↑WBC ↑ ↑ ↑ - - - ↑ - - - - - - - - - Positive

Bone turnover markers

When bone mineral density (BMD) measurements do not provide a clear answer, bone turnover markers can be used in selected cases to assess the fracture risk. The combined use of BMD measurements and bone markers is likely to improve the assessment. Bone turnover markers are not routinely employed in diagnosing osteoporosis. Bone markers have two different types:

  • Bone formation markers
  • Bone resorption markers
Group Test Result Outcome
Bone formation markers Serum osteocalcin[1] Elevated
Serum bone–specific alkaline phosphatase[2] 30 percent reduction
Serum type 1 procollagen[2] 30 percent reduction
Bone resorption markers Urinary hydroxyproline[3] Elevated
Urinary total pyridinoline (PYD)[4] Elevated
Urinary free deoxypyridinoline (DPD)[5] Elevated
Tartrate-resistant acid phosphatase 5b[6] Elevated
Bone sialoprotein (BSP)[7] Reduced after antiresorptive medicine
Urinary collagen type 1 cross-linked N-telopeptide (NTX)[8] Reduced to half
Serum collagen type 1 cross-linked C-telopeptide (CTX)[2] 30 percent reduction

References

  1. ↑
  2. ↑ 2.0 2.1 2.2
  3. ↑
  4. ↑
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