Osteoporosis laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(46 intermediate revisions by 12 users not shown)
Line 1: Line 1:
__NOTOC__
{{Osteoporosis}}
{{Osteoporosis}}
{{CMG}}
{{CMG}}; {{AE}}{{EG}}
__NOTOC__
'''Associate Editor(s)-In-Chief:''' {{CZ}}, [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]][mailto:rgudetti@perfuse.org]


==Overview==
==Overview==
Lab 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 also tests for diagnosing secondary osteoporosis, which include 24 hr serum calcium, serum protein electrophoresis and [[bone marrow biopsy]].
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]]. [[Laboratory techniques|Laboratory tests]] for the [[diagnosis]] of osteoporosis include some baseline tests like [[Complete blood count|complete blood count (CBC)]], [[Calcium|serum calcium]], [[phosphate]], [[alkaline phosphatase]], and [[Vitamin D|25-(OH)-vitamin D]]. There are tests for diagnosing secondary osteoporosis, which include but not limited to 24 hr [[Calcium|serum calcium]], serum [[protein electrophoresis]], and serum [[Thyroid hormone|thyroid hormones]].


==Lab tests==
==Laboratory findings==
===Baseline tests===
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.  
* [[Complete blood count]] - in anemia especially [[sickle cell anemia]], [[multiple myeloma]], and [[alcoholism]]
* Serum [[calcium]] levels - can reflect underlying disease states (e.g, severe [[hypercalcemia]] may reflect underlying [[malignancy]] or [[hyperparathyroidism]]; [[hypocalcemia]] can contribute to osteoporosis) 
* Serum [[phosphate]] and [[alkaline phosphatase]]
* Serum 25 (OH) [[vitamin D]] levels
* Serum creatinine levels - reflect chronic renal failure which leads to [[renal osteodystrophy]]
* Serum [[magnesium]] levels - important in calcium homeostasis
* Serum iron and ferritin levels - for excluding [[hemochromatosis]]
* [[Liver function tests]] ([[alanine aminotransferase]], [[aspartate amiontransferase]], [[gama-glutamyl transferase]], [[bilirubin]]) - aids in diagnosing alcoholism
* [[Thyroid function tests]]


===Tests for secondary osteoporosis===
=== Electrolyte and Biomarker Studies ===
* 24-hr serum calcium
<br><span style="font-size:85%">Abbreviations:</span>
* Serum [[parathyroid hormone]] (PTH) levels
* [[Testorone]] and gonadotropin levels - in men
* Urine free cortisol levels
* Over night dexamethasone suppression test - for [[cushing's syndrome]]
* [[Serum protein electrophoresis]] (SPEP) and Urine protein electrophoresis - for [[multiple myeloma]]
* Antigliadin and anti-endomysial antibodies - for [[celiac disease]]
* Serum tryptase and urine N-methylhistamine - for identifying [[mastocytosis]]
* [[Bone marrow biopsy]] - for hematological disorders


===Bone turnover markers===
<span style="font-size:85%">HGB: Hemoglobin</span>
When [[bone mineral density]] ([[BMD]]) measurement does not provide a clear answer bone turnover markers can be used in selected cases to assess fracture risk.  The combined use of BMD measurement and bone markers is likely to improve the assessment.
Bone markers are of two types:
* Bone formation markers:  
** Serum total alkaline phosphatase
** Serum bone–specific alkaline phosphatase
** Serum type 1 procollagen
** Serum osteocalcin
* Bone resorption markers:
** Urinary hydroxyproline
** Urinary total pyridinoline (PYD)
** Urinary free deoxypyridinoline (DPD)
** Tartrate-resistant acid phosphatase 5b
** Bone sialoprotein (BSP)
** Urinary collagen type 1 cross-linked N-telopeptide (NTX)
** Urinary or serum collagen type 1 cross-linked C-telopeptide (CTX)
 
Bone turnover markers are not routinely employed in diagnosing osteoporosis.


<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"
! rowspan="2" |Disease
! colspan="18" |Electrolyte and Bio-marker Studies
|- style="background:LightGrey"
| [[Complete blood count|Complete blood count (CBC)]]
| Serum [[calcium]] level
| 24-hr serum [[calcium]]
| Serum [[phosphate]] level
| Serum [[alkaline phosphatase]] level
| Serum [[Vitamin D|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|parathyroid hormone (PTH)]] level
| Serum [[Testosterone]]/[[gonadotropin]] level
| Urine free [[cortisol]] level
| [[Dexamethasone suppression test|Over night dexamethasone suppression test]]
| [[Serum protein electrophoresis]]/ Urine [[protein electrophoresis]]
| [[Anti-gliadin antibodies|Anti-gliadin]] <br> Anti-endomysial antibodies
| Serum [[tryptase]] <br> Urine N-methylhistamine
|-
| [[Postmenopausal osteoporosis]]
| -
| -
| -
| -
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Vitamin D deficiency]]
| -
| ↓
| ↓
| ↓
| ↑
| ↓
| ↓
| -
| -
| -
| -
| ↓
| -
| -
| -
| -
| -
| -
|-
| [[Sickle cell anemia]]
| ↓[[Hemoglobin|HGB]]
| -
| -
| -
| ↑
| -
| -
| -
| ↓
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Multiple myeloma]]
| ↓[[Hemoglobin|HGB]]
| ↑
| ↑
| ↑
| ↑
| -
| -
| ↑
| ↓
| -
| -
| -
| -
| -
| -
| ↑ [[IgM]]
| -
| -
|-
| [[Leukemia]]/[[lymphoma]]
| ↑[[WBC]]
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Alcoholism]]
| ↓[[Hemoglobin|HGB]]
| -
| -
| -
| -
| -
| -
| -
| ↓
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
|-
| [[Aplasia]]
| ↓[[Red blood cell|RBC]], ↓[[WBC]], ↓[[Platelet|PLT]]
| -
| -
| -
| -
| -
| -
| -
| ↓
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Malignancy]]
| -
| ↑↑↑
| ↑↑↑
| ↑
| ↑
| -
| -
| ↑
| -
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
|-
| [[Hypophosphatemic rickets]]
| -
| ↓↓
| ↓
| ↓
| ↑
| ↓↓
| ↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Chronic kidney disease]]
| ↓[[Hemoglobin|HGB]]
| ↑↑
| ↑↑
| ↓↓
| -
| ↓
| ↑
| ↑↑↑
| ↓
| -
| -
| -
| -
| -
| -
| ↑ Urine protein
| -
| -
|-
| Destructive [[bone]] [[diseases]] (e.g., [[bone tumors]])
| -
| ↑↑
| ↑↑
| ↑
| ↑↑↑
| -
| -
| ↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Liver diseases]]
| ↓[[Hemoglobin|HGB]]
| -
| -
| -
| -
| -
| -
| -
| -
| ↑↑
| -
| -
| -
| -
| -
| -
| -
| -
|-
| [[Hemochromatosis]]
| ↑[[Hematocrit|HCT]]
| -
| -
| -
| -
| -
| -
| ↑
| ↑↑↑
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Hyperthyroidism]]
| -
| -
| ↑
| ↑
| -
| -
| -
| -
| -
| -
| ↑↑
| -
| -
| -
| -
| -
| -
| -
|-
| [[Hypoparathyroidism]]
| -
| ↓
| ↓
| ↑
| ↓
| -
| ↓
| -
| -
| -
| -
| ↓↓
| -
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Hyperparathyroidism]]
| -
| ↑
| ↑
| ↓
| ↑
| -
| ↑
| -
| -
| -
| -
| ↑↑
| -
| -
| -
| -
| -
| -
|-
| [[Hypogonadism]]
| ↓[[Hemoglobin|HGB]]
| -
| ↓
| ↓
| -
| -
| -
| -
| -
| -
| -
| -
| ↓↓
| -
| -
| -
| -
| -
|- style="background:#efefef;"
| [[Cushing's syndrome|Hypercortisolism (Cushing's syndrome)]]
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| ↑↑
| not suppresed
| -
| -
| -
|-
| [[Celiac disease]]
| ↓[[Hemoglobin|HGB]]
| ↓
| ↓
| ↓
| ↑
| ↓
| ↓
| ↓
| ↓↓
| -
| ↓
| -
| -
| -
| -
| ↓ Plasma protein
| Positive
| -
|- style="background:#efefef;"
| [[Mastocytosis]]
| ↑[[WBC]]
| ↑
| ↑
| ↑
| -
| -
| -
| ↑
| -
| -
| -
| -
| -
| -
| -
| -
| -
|  Positive
|}</small></small> 


===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


* Bone resorption markers
{| cellpadding="2" border="1" align="center"
! style="background:#efefef;" |Group
! style="background:#efefef;" |Test
! style="background:#efefef;" |Result
! style="background:#efefef;" |Outcome
|-
| rowspan="3" |'''Bone formation markers'''
| Serum [[osteocalcin]]<ref name="pmid26436008" />
| Elevated
|
* [[Postmenopausal]] [[osteoporosis]]
|-
| Serum bone–specific [[alkaline phosphatase]]<ref name="pmid15231011" />
| 30 percent reduction
|
* Treatment efficacy
* Increasing [[Bone mineral density|bone mineral density (BMD)]]
* Decreasing [[fracture]] risk
|-
| Serum type 1 [[procollagen]]<ref name="pmid15231011" />
| 30 percent reduction
|
* Treatment efficacy
* Increasing [[Bone mineral density|bone mineral density (BMD)]]
* Decreasing [[fracture]] risk
|-
| rowspan="7" |'''Bone resorption markers'''
| Urinary [[hydroxyproline]]<ref name="pmid2099937" />
| Elevated
|
* [[Postmenopausal]] [[osteoporosis]]
|-
| Urinary total pyridinoline (PYD)<ref name="pmid1887826" />
| Elevated
|
* [[Postmenopausal]] [[osteoporosis]]
* Higher [[hip]] [[fracture]] risk
|-
| Urinary free deoxypyridinoline (DPD)<ref name="pmid8889854" />
| Elevated
|
* Higher bone resorption in [[postmenopausal]] female
* [[Lumbar spine]] [[osteoporosis]]
|-
| [[Tartrate resistant acid phosphatase|Tartrate-resistant acid phosphatase 5b]]<ref name="pmid19453262" />
| Elevated
|
* More severe [[osteoporosis]] in [[hip]]
|-
| [[Bone sialoprotein|Bone sialoprotein (BSP)]]<ref name="pmid11763409" />
| Reduced after antiresorptive medicine
|
* Decrease in [[bone]] mass loss
* Improving [[lumbar vertebrae]] [[Bone mineral density|BMD]]
|-
| Urinary [[collagen]] type 1 cross-linked N-telopeptide (NTX)<ref name="pmid12817758" />
| Reduced to half 
|
* Increase in [[Bone mineral density|BMD]]
* Decrease in [[fracture]] risk
|-
| Serum [[collagen]] type 1 cross-linked C-telopeptide (CTX)<ref name="pmid15231011" />
| 30 percent reduction
|
* Treatment efficacy
* Increasing [[Bone mineral density|bone mineral density (BMD)]]
* Decreasing [[fracture]] risk
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WS}}
{{WH}}


​​


 
[[Category:Medicine]]
[[Category:Grammar]]
[[Category:Endocrinology]]
 
[[Category:Up-To-Date]]
 
 
 
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Latest revision as of 23:28, 29 July 2020

Osteoporosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Osteoporosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Life Style Modification
Pharmacotherapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Osteoporosis laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Osteoporosis laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Osteoporosis laboratory findings

CDC on Osteoporosis laboratory findings

Osteoporosis laboratory findings in the news

Blogs on Osteoporosis laboratory findings

Directions to Hospitals Treating Osteoporosis

Risk calculators and risk factors for Osteoporosis laboratory findings

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. ↑
  5. ↑
  6. ↑
  7. ↑
  8. ↑

Template:WS Template:WH

​​

Retrieved from "https://www.wikidoc.org/index.php?title=Osteoporosis_laboratory_findings&oldid=1641538"