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==Overview== | ==Overview== | ||
Lab tests for the diagnosis of [[osteoporosis]] include some baseline tests like [[complete blood count]] (CBC), [[serum calcium]], [[phosphate]], [[alkaline phosphatase]], and | There is a limited role for [[Laboratory techniques|laboratory tests]] in diagnosis of [[osteoporosis]]; however, they may be used for differentiating primary versus secondary causes of the disease. [[Laboratory techniques|Lab tests]] for the [[diagnosis]] of [[osteoporosis]] include some baseline tests like [[complete blood count]] (CBC), [[Calcium|serum calcium]], [[phosphate]], [[alkaline phosphatase]], and [[Vitamin D|25-(OH)-vitamin D]]. There are also tests for diagnosing secondary [[osteoporosis]], which include 24 hr [[Calcium|serum calcium]], serum [[protein electrophoresis]], and serum [[Thyroid hormone|thyroid hormones]]. | ||
==Laboratory findings== | ==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. | There is a limited role for [[Laboratory techniques|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=== | ===Electrolyte and Bio-marker Studies=== | ||
==== [[Complete blood count|Complete blood count (CBC)]] ==== | ==== [[Complete blood count|Complete blood count (CBC)]] ==== | ||
* Reduced hemoglobin level may reveal [[sickle cell anemia]], [[multiple myeloma]], or [[alcoholism]] associated osteoporosis | * Reduced [[hemoglobin]] level may reveal [[sickle cell anemia]], [[multiple myeloma]], or [[alcoholism]] associated [[osteoporosis]] | ||
* Elevated WBC count may reveal leukemia/lymphoma 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 | * Reduced number of all cell types ([[RBC]], [[WBC]], and [[platelet]]) may reveal [[aplasia]] associated [[osteoporosis]] | ||
==== Serum [[calcium]] level and/or 24-hr serum calcium ==== | ==== Serum [[calcium]] level and/or 24-hr serum [[calcium]] ==== | ||
* Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] associated osteoporosis | * Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] associated [[osteoporosis]] | ||
* [[hypocalcemia]] may reflect vitamin D deficiency | * [[hypocalcemia]] may reflect [[vitamin D deficiency]] associated [[osteoporosis]] | ||
==== Serum [[phosphate]] level ==== | ==== Serum [[phosphate]] level ==== | ||
* Reduced serum [[phosphate]] level may reveal '''hypophosphatemic rickets''' | * Reduced serum [[phosphate]] level may reveal '''[[hypophosphatemic rickets]]''' associated [[osteoporosis]] | ||
* Elevated serum [[phosphate]] level may reveal vitamin D deficiency, chronic kidney disease | * Elevated serum [[phosphate]] level may reveal [[vitamin D deficiency]], or [[chronic kidney disease]] associated [[osteoporosis]] | ||
==== Serum [[alkaline phosphatase]] level ==== | ==== Serum [[alkaline phosphatase]] level ==== | ||
* Elevated serum [[alkaline phosphatase]] level may reveal postmenopausal or destructive bone diseases (e.g., bone | * Elevated serum [[alkaline phosphatase]] level may reveal [[postmenopausal]] or destructive [[bone]] [[diseases]] (e.g., [[bone tumors]]) associated [[osteoporosis]] | ||
==== Serum 25-(OH)- | ==== Serum [[Vitamin D|25-(OH)-vitamin D]] level ==== | ||
* Reduced serum 25-(OH)- | * Reduced serum [[Vitamin D|25-(OH)-vitamin D]] level may reveal [[vitamin D deficiency]] associated [[osteoporosis]] | ||
==== Serum creatinine level ==== | ==== Serum [[creatinine]] level ==== | ||
* Reduced serum creatinine level may reflect [[chronic renal failure]], which leads to [[renal osteodystrophy]] | * Reduced serum [[creatinine]] level may reflect [[chronic renal failure]], which leads to [[renal osteodystrophy]] | ||
==== Serum [[magnesium]] level ==== | ==== Serum [[magnesium]] level ==== | ||
* Reduced magnesium level may reflect vitamin D deficiency associated osteoporosis | * Reduced [[magnesium]] level may reflect [[vitamin D deficiency]] associated [[osteoporosis]] | ||
==== Serum iron and ferritin levels ==== | ==== Serum [[iron]] and [[ferritin]] levels ==== | ||
* Elevated iron and ferritin serum levels may reveal [[hemochromatosis]] associated osteoporosis | * Elevated [[iron]] and [[ferritin]] serum levels may reveal [[hemochromatosis]] associated [[osteoporosis]] | ||
[[Liver function tests]] ([[alanine aminotransferase]], [[aspartate aminotransferase]], [[gamma-glutamyl transferase]], and [[bilirubin]]) | [[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 | * Elevated level of [[liver function tests]] may reflect [[liver diseases]] (e.g., [[alcoholism]]) associated [[osteoporosis]] | ||
==== [[Thyroid function tests]] ==== | ==== [[Thyroid function tests]] ==== | ||
* Reduced thyroid stimulating hormone (TSH) and elevated free thyroxin (T4) may reveal hyperthyroidism associated osteoporosis | * Reduced [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]] and elevated [[Thyroxin|free thyroxin (T4)]] may reveal [[hyperthyroidism]] associated [[osteoporosis]] | ||
==== Serum [[parathyroid hormone | ==== Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level ==== | ||
* Elevated Serum [[parathyroid hormone | * 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 ==== | ==== [[Testosterone]] and [[gonadotropin]] levels ==== | ||
* Reduced testosterone and gonadotropin levels in men may reveal hypogonadism associated osteoporosis | * Reduced [[testosterone]] and [[gonadotropin]] levels in men may reveal [[hypogonadism]] associated [[osteoporosis]] | ||
==== Urine free cortisol level ==== | ==== Urine free [[cortisol]] level ==== | ||
* Elevated | * Elevated urine free [[cortisol]] level may reflect [[Cushing's syndrome|hypercortisolism (Cushing's syndrome)]] associated [[osteoporosis]] | ||
==== Other bio-markers tests ==== | ==== Other bio-markers tests ==== | ||
* Over night dexamethasone suppression test (for identifying [[cushing's syndrome]] associated osteoporosis) | * [[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) | * [[Serum protein electrophoresis]] (SPEP) and urine [[protein electrophoresis]] (for identifying [[multiple myeloma]] associated [[osteoporosis]]) | ||
* Anti-gliadin and anti-endomysial antibodies (for identifying [[celiac disease]] 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) | * Serum [[tryptase]] and urine N-methylhistamine (for identifying [[mastocytosis]] associated [[osteoporosis]]) | ||
=== Bone turnover markers === | === Bone turnover markers === | ||
When [[bone mineral density | 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]] formation markers ===== | ||
* Serum [[osteocalcin]]; elevated serum osteocalcin level in postmenopausal women reveal primary osteoporosis, also lower 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 [[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 (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 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 | * 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]] 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 for 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}} | ||
Revision as of 14:50, 7 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
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. 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 serum thyroid hormones.
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 associated osteoporosis
Serum phosphate level
- Reduced serum phosphate level may reveal hypophosphatemic rickets associated osteoporosis
- 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
- 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
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
- Reduced Serum parathyroid hormone (PTH) level may reveal decreased bone turnover and also increased 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.[1]
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 syndrome) associated osteoporosis
Other bio-markers tests
- 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 and anti-endomysial antibodies (for identifying celiac disease associated osteoporosis)
- Serum tryptase and urine N-methylhistamine (for identifying mastocytosis associated osteoporosis)
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
- Serum osteocalcin; elevated serum osteocalcin level in postmenopausal women reveal primary osteoporosis, also lower BMD in femoral neck and lumbar vertebrae[2]
- Serum bone–specific alkaline phosphatase; 30 percent reduction may reflect treatment efficacy, increasing bone mineral density (BMD) and decreasing fracture risk[3]
- Serum type 1 procollagen; 30 percent reduction may reflect treatment efficacy, increasing BMD and decreasing fracture risk[3]
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[4]
- Urinary total pyridinoline (PYD); elevated level may reflect higher bone resorption in postmenopausal female with lumbar spine osteoporosis[5]
- Urinary free deoxypyridinoline (DPD); elevated levels in postmenopausal female correspond with osteoporosis and higher hip fracture risk[6]
- Tartrate-resistant acid phosphatase 5b; elevated levels may reflect more severe osteoporosis in hip[7]
- Bone sialoprotein (BSP); reduced levels after antiresorptive medicines reflect the decrease in bone mass loss and improving lumbar vertebrae BMD[8]
- Urinary collagen type 1 cross-linked N-telopeptide (NTX); reduced level to half of the original measure may reveal increase in BMD and decrease in fracture risk[9]
- Serum collagen type 1 cross-linked C-telopeptide (CTX); reduced level for 30 percent may reflect treatment efficacy, increasing bone mineral density (BMD) and decreasing fracture risk[3]
References
- ↑ Rubin MR, Bilezikian JP (2010). "Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement". Arq Bras Endocrinol Metabol. 54 (2): 220–6. PMC 3702727. PMID 20485912.
- ↑ Singh S, Kumar D, Lal AK (2015). "Serum Osteocalcin as a Diagnostic Biomarker for Primary Osteoporosis in Women". J Clin Diagn Res. 9 (8): RC04–7. doi:10.7860/JCDR/2015/14857.6318. PMC 4576601. PMID 26436008.
- ↑ 3.0 3.1 3.2 Bauer DC, Black DM, Garnero P, Hochberg M, Ott S, Orloff J, Thompson DE, Ewing SK, Delmas PD (2004). "Change in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: the fracture intervention trial". J. Bone Miner. Res. 19 (8): 1250–8. doi:10.1359/JBMR.040512. PMID 15231011.
- ↑ Gnudi S, Ripamonti C, Bonini AM, Pratelli L, Figus E (1990). "The importance of urinary hydroxyproline and serumal osteocalcin in the evaluation of post-menopausal osteoporosis". Ital J Orthop Traumatol. 16 (4): 551–7. PMID 2099937.
- ↑ Delmas PD, Schlemmer A, Gineyts E, Riis B, Christiansen C (1991). "Urinary excretion of pyridinoline crosslinks correlates with bone turnover measured on iliac crest biopsy in patients with vertebral osteoporosis". J Bone Miner Res. 6 (6): 639–44. doi:10.1002/jbmr.5650060615. PMID 1887826.
- ↑ Garnero P, Hausherr E, Chapuy MC, Marcelli C, Grandjean H, Muller C, Cormier C, Bréart G, Meunier PJ, Delmas PD (1996). "Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study". J. Bone Miner. Res. 11 (10): 1531–8. doi:10.1002/jbmr.5650111021. PMID 8889854.
- ↑ Bauer DC, Garnero P, Harrison SL, Cauley JA, Eastell R, Ensrud KE, Orwoll E (2009). "Biochemical markers of bone turnover, hip bone loss, and fracture in older men: the MrOS study". J. Bone Miner. Res. 24 (12): 2032–8. doi:10.1359/jbmr.090526. PMID 19453262.
- ↑ Shaarawy M, Hasan M (2001). "Serum bone sialoprotein: a marker of bone resorption in postmenopausal osteoporosis". Scand. J. Clin. Lab. Invest. 61 (7): 513–21. PMID 11763409.
- ↑ Eastell R, Barton I, Hannon RA, Chines A, Garnero P, Delmas PD (2003). "Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate". J. Bone Miner. Res. 18 (6): 1051–6. doi:10.1359/jbmr.2003.18.6.1051. PMID 12817758.