Osteoporosis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Osteoporosis}} | {{Osteoporosis}} | ||
{{CMG}}; {{AE}} {{CZ}}, [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]][mailto:ravitheja.g@gmail.com] | {{CMG}}; {{AE}}{{CZ}}, [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]][mailto:ravitheja.g@gmail.com] | ||
==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]]. | 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]]. | ||
==Laboratory | ==Laboratory findings== | ||
There is a limited role for laboratory tests in diagnosis of osteoporosis; however, they may be used for differentiating primary versus secondary causes of the disease. | |||
===Electrolyte and | ===Electrolyte and Bio-marker Studies=== | ||
==== | ==== [[Complete blood count|Complete blood count (CBC)]] ==== | ||
* Reduced hemoglobin level may reveal [[sickle cell anemia]], [[multiple myeloma]], or [[alcoholism]] associated osteoporosis | |||
* | * Elevated 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 ==== | ||
* Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] associated osteoporosis | |||
* [[hypocalcemia]] may reflect vitamin D deficiency or hypoparathyroidism associated [[osteoporosis]] | |||
* | |||
* | |||
====Bone turnover markers | ==== Serum [[phosphate]] level ==== | ||
When [[bone mineral density]] ([[BMD]]) measurements do not provide a clear answer, bone turnover markers can be used in selected cases to assess fracture risk. | * Reduced serum [[phosphate]] level may reveal '''hypophosphatemic rickets''' or nephrolithiasis osteoporosis type 1 (NPHLOP1) associated osteoporosis | ||
* Elevated serum [[phosphate]] level may reveal vitamin D deficiency, chronic kidney disease, or hypoparathyroidism associated osteoporosis | |||
==== Serum [[alkaline phosphatase]] level ==== | |||
* Elevated serum [[alkaline phosphatase]] level may reveal postmenopausal or destructive bone diseases (e.g., bone tumor) associated osteoporosis | |||
==== Serum 25-(OH)-[[vitamin D]] level ==== | |||
* Reduced serum 25-(OH)-[[vitamin D]] level may reveal vitamin D deficiency associated osteoporosis | |||
==== Serum creatinine level ==== | |||
* Reduced 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 <ref name="pmid23912329">{{cite journal| author=Castiglioni S, Cazzaniga A, Albisetti W, Maier JA| title=Magnesium and osteoporosis: current state of knowledge and future research directions. | journal=Nutrients | year= 2013 | volume= 5 | issue= 8 | pages= 3022-33 | pmid=23912329 | doi=10.3390/nu5083022 | pmc=3775240 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23912329 }}</ref> | |||
==== 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]]) | |||
* Elevated level of liver function tests may reflect liver diseases (e.g., alcoholism) associated osteoporosis | |||
==== [[Thyroid function tests]] ==== | |||
* Reduced thyroid stimulating hormone (TSH) and elevated free thyroxin (T4) may reveal hyperthyroidism associated osteoporosis | |||
==== Serum [[parathyroid hormone]] (PTH) level ==== | |||
* Elevated Serum [[parathyroid hormone]] (PTH) level may reflect hyperparathyroidism associated osteoporosis | |||
==== 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 hypercortisolism (Cushing's disease) associated osteoporosis | |||
==== Other bio-markers tests ==== | |||
* Over night dexamethasone suppression test (for identifying [[cushing's syndrome]]) | |||
* [[Serum protein electrophoresis]] (SPEP) and urine protein electrophoresis (for identifying [[multiple myeloma]]) | |||
* Anti-gliadin and anti-endomysial antibodies (for identifying [[celiac disease]]) | |||
* Serum tryptase and urine N-methylhistamine (for identifying [[mastocytosis]]) | |||
=== 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 fracture risk. The combined use of BMD measurements and bone markers is likely to improve the assessment. | |||
Bone markers have two different types: | Bone markers have two different 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. | [[Bone turnover markers]] are not routinely employed in diagnosing osteoporosis. | ||
[[Bone marrow biopsy]] - for hematological disorders | |||
==References== | ==References== | ||
Revision as of 19:50, 4 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3]
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.
Laboratory findings
There is a limited role for laboratory tests in diagnosis of osteoporosis; however, they may be used for differentiating primary versus secondary causes of the disease.
Electrolyte and Bio-marker Studies
Complete blood count (CBC)
- Reduced hemoglobin level may reveal sickle cell anemia, multiple myeloma, or alcoholism associated osteoporosis
- Elevated 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
- Severe hypercalcemia may reflect malignancy or hyperparathyroidism associated osteoporosis
- hypocalcemia may reflect vitamin D deficiency or hypoparathyroidism associated osteoporosis
Serum phosphate level
- Reduced serum phosphate level may reveal hypophosphatemic rickets or nephrolithiasis osteoporosis type 1 (NPHLOP1) associated osteoporosis
- Elevated serum phosphate level may reveal vitamin D deficiency, chronic kidney disease, or hypoparathyroidism associated osteoporosis
Serum alkaline phosphatase level
- Elevated serum alkaline phosphatase level may reveal postmenopausal or destructive bone diseases (e.g., bone tumor) associated osteoporosis
Serum 25-(OH)-vitamin D level
- Reduced serum 25-(OH)-vitamin D level may reveal vitamin D deficiency associated osteoporosis
Serum creatinine level
- Reduced 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 [1]
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)
- Elevated level of liver function tests may reflect liver diseases (e.g., alcoholism) associated osteoporosis
Thyroid function tests
- Reduced thyroid stimulating hormone (TSH) and elevated free thyroxin (T4) may reveal hyperthyroidism associated osteoporosis
Serum parathyroid hormone (PTH) level
- Elevated Serum parathyroid hormone (PTH) level may reflect hyperparathyroidism associated osteoporosis
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 hypercortisolism (Cushing's disease) associated osteoporosis
Other bio-markers tests
- Over night dexamethasone suppression test (for identifying cushing's syndrome)
- Serum protein electrophoresis (SPEP) and urine protein electrophoresis (for identifying multiple myeloma)
- Anti-gliadin and anti-endomysial antibodies (for identifying celiac disease)
- Serum tryptase and urine N-methylhistamine (for identifying mastocytosis)
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 fracture risk. The combined use of BMD measurements and bone markers is likely to improve the assessment. Bone markers have two different 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.
Bone marrow biopsy - for hematological disorders
References
- ↑ Castiglioni S, Cazzaniga A, Albisetti W, Maier JA (2013). "Magnesium and osteoporosis: current state of knowledge and future research directions". Nutrients. 5 (8): 3022–33. doi:10.3390/nu5083022. PMC 3775240. PMID 23912329.