Osteoporosis laboratory findings: Difference between revisions

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Revision as of 15:36, 15 August 2017

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 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.

Group	Test	Result	Osteoporosis related disease
Bone formation markers	Serum osteocalcin	Elevated	Postmenopausal osteoporosis
	Serum bone–specific alkaline phosphatase	30 percent reduction	Treatment efficacy, increasing bone mineral density (BMD) and decreasing fracture risk
	Serum type 1 procollagen	30 percent reduction	Treatment efficacy, increasing bone mineral density (BMD) and decreasing fracture risk
Bone resorption markers	Urinary hydroxyproline	Elevated	Postmenopausal osteoporosis
	Urinary total pyridinoline (PYD)	Elevated	Postmenopausal osteoporosis Higher hip fracture risk
	Urinary free deoxypyridinoline (DPD)	Elevated	Higher bone resorption in postmenopausal female Lumbar spine osteoporosis
	Tartrate-resistant acid phosphatase 5b	Elevated	More severe osteoporosis in hip
	Bone sialoprotein (BSP)	Reduced after antiresorptive medicine	Decrease in bone mass loss Improving lumbar vertebrae BMD
	Urinary collagen type 1 cross-linked N-telopeptide (NTX)	Reduced to half	Increase in BMD Decrease in fracture risk
	Serum collagen type 1 cross-linked C-telopeptide (CTX)	30 percent reduction	Treatment efficacy Increasing bone mineral density (BMD) Decreasing fracture risk

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 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]

Disease	Electrolyte and Bio-marker Studies
Disease	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 and gonadotropin level	Urine free cortisol level	Over night dexamethasone suppression test	Serum protein electrophoresis (SPEP) Urine protein electrophoresis	Anti-gliadin Anti-endomysial antibodies	Serum tryptase Urine N-methylhistamine
Postmenopausal
Vitamin D deficiency
Sickle cell anemia
Multiple myeloma
Leukemia/lymphoma
Alcoholism
Aplasia
Malignancy
Hyperparathyroidism
Hypophosphatemic rickets
Chronic kidney disease
Destructive bone diseases (e.g., bone tumors)
Chronic renal failure
Hemochromatosis
Liver diseases
Hyperthyroidism
Hypoparathyroidism
Hyperparathyroidism]
Hypogonadism
Hypercortisolism (Cushing's syndrome)
Cushing's syndrome
Multiple myeloma
Celiac disease
Mastocytosis

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.

Template:WS Template:WH

[pmid20485912-1] 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.

[pmid26436008-2] 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.

[pmid15231011-3] 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.

[pmid2099937-4] 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.

[pmid1887826-5] 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.

[pmid8889854-6] 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.

[pmid19453262-7] 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.

[pmid11763409-8] 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.

[pmid12817758-9] 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.

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@@ Line 9: / Line 9: @@
 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.
-{|border="1" cellpadding="2"
+{|border="1" cellpadding="2" align="center"
-|-style="background:LightGrey"
+! style="background:#efefef;" |Group
-! Group
+! style="background:#efefef;" |Test
-! Test
+! style="background:#efefef;" |Result
-! Result
+! style="background:#efefef;" |Osteoporosis related disease
-! Osteoporosis related disease
-|-
-| rowspan="22"|Electrolyte and Bio-marker Studies
-| rowspan="3"|[[Complete blood count|Complete blood count (CBC)]]
-| Reduced [[hemoglobin]] level
-| [[Sickle cell anemia]], [[multiple myeloma]], or [[alcoholism]]
 |-
-| Elevated [[White blood cells|WBC]] count
-| [[Leukemia]]/[[lymphoma]]
-|-
-| Reduced number of all cell types ([[RBC]], [[WBC]], and [[platelet]])
-| [[Aplasia]]
-|-style="background:Gainsboro"
-| rowspan="2"|Serum [[calcium]] level and/or 24-hr serum [[calcium]]
-| Severe [[hypercalcemia]]
-| [[Malignancy]] or [[hyperparathyroidism]] associated [[osteoporosis]]
-|-style="background:Gainsboro"
-| [[Hypocalcemia]]
-| [[Vitamin D deficiency]]
-|-
-| rowspan="2"| Serum [[phosphate]] level
-| Reduced
-| [[Hypophosphatemic rickets]]
-|-
-| Elevated
-| [[Vitamin D deficiency]], or [[chronic kidney disease]]
-|-style="background:Gainsboro"
-| Serum [[alkaline phosphatase]] level
-| Elevated
-| [[Postmenopausal]] or destructive [[bone]] [[diseases]] (e.g., [[bone tumors]])
-|-
-| Serum [[Vitamin D|25-(OH)-vitamin D]] level
-| Reduced
-| [[Vitamin D deficiency]]
-|-style="background:Gainsboro"
-| Serum [[creatinine]] level
-| Elevated
-| [[Chronic renal failure]]
-|-
-| Serum [[magnesium]] level
-| Reduced
-| [[Vitamin D deficiency]]
-|-style="background:Gainsboro"
-| Serum [[iron]] and [[ferritin]] level
-| Elevated
-| [[Hemochromatosis]]
-|-
-| [[Liver function tests]]
-| Elevated
-| [[Liver diseases]] (e.g., [[alcoholism]])
-|-style="background:Gainsboro"
-| [[Thyroid function tests]]
-| Reduced [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]]<br>Elevated [[Thyroxin|free thyroxin (T4)]]
-| [[Hyperthyroidism]]
-|-
-| rowspan="2"| Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level
-| Reduced
-| [[Hypoparathyroidism]]*
-|-
-| Elevated
-| [[Hyperparathyroidism]]]
-|-style="background:Gainsboro"
-| Serum [[Testosterone]] and [[gonadotropin]] level
-| Reduced
-| [[Hypogonadism]]
-|-
-| Urine free [[cortisol]] level
-| Elevated
-| [[Cushing's syndrome|Hypercortisolism (Cushing's syndrome)]]
-|-style="background:Gainsboro"
-| [[Dexamethasone suppression test|Over night dexamethasone suppression test]]
-| Not suppressed
-| [[Cushing's syndrome]]
-|-
-| [[Serum protein electrophoresis]] (SPEP) <br> Urine [[protein electrophoresis]]
-| Elevated IgM
-| [[Multiple myeloma]]
-|-style="background:Gainsboro"
-| [[Anti-gliadin antibodies|Anti-gliadin]] <br> Anti-endomysial antibodies
-| Positive
-| [[Celiac disease]]
-|-
-| Serum [[tryptase]] <br> Urine N-methylhistamine
-| Elevated
-| [[Mastocytosis]]
-|-style="background:Gainsboro"
 | rowspan="3"|[[Bone]] formation markers
 | Serum [[osteocalcin]]
 | Elevated
 | [[Postmenopausal]] [[osteoporosis]]
-|-style="background:Gainsboro"
+|-
 | Serum bone–specific [[alkaline phosphatase]]
 | 30 percent reduction
 | Treatment efficacy, increasing [[Bone mineral density|bone mineral density (BMD)]] and decreasing [[fracture]] risk
-|-style="background:Gainsboro"
+|-
 | Serum type 1 [[procollagen]]
 | 30 percent reduction
@@ Line 117: / Line 32: @@
 | Elevated
 | [[Postmenopausal]] [[osteoporosis]]
-|-style="background:Gainsboro"
+|-
 | Urinary total pyridinoline (PYD)
 | Elevated
@@ Line 125: / Line 40: @@
 | Elevated
 | Higher bone resorption in [[postmenopausal]] female <br> [[Lumbar spine]] [[osteoporosis]]
-|-style="background:Gainsboro"
+|-
 | [[Tartrate resistant acid phosphatase|Tartrate-resistant acid phosphatase 5b]]
 | Elevated
@@ Line 133: / Line 48: @@
 | Reduced after antiresorptive medicine
 | Decrease in [[bone]] mass loss <br> Improving [[lumbar vertebrae]] [[Bone mineral density|BMD]]
-|-style="background:Gainsboro"
+|-
 | Urinary [[collagen]] type 1 cross-linked N-telopeptide (NTX)
 | Reduced to half
@@ Line 211: / Line 126: @@
 *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" />
+{|border="1" cellpadding="2"
+|-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]] and [[gonadotropin]] level
+| Urine free [[cortisol]] level
+| [[Dexamethasone suppression test|Over night dexamethasone suppression test]]
+| [[Serum protein electrophoresis]] (SPEP) <br> Urine [[protein electrophoresis]]
+| [[Anti-gliadin antibodies|Anti-gliadin]] <br> Anti-endomysial antibodies
+| Serum [[tryptase]] <br> Urine N-methylhistamine
+|-
+| [[Postmenopausal]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Vitamin D deficiency]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Sickle cell anemia]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Multiple myeloma]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Leukemia]]/[[lymphoma]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Alcoholism]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Aplasia]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Malignancy]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Hyperparathyroidism]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Hypophosphatemic rickets]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Chronic kidney disease]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| Destructive [[bone]] [[diseases]] (e.g., [[bone tumors]])
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Chronic renal failure]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Hemochromatosis]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Liver diseases]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Hyperthyroidism]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Hypoparathyroidism]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Hyperparathyroidism]]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Hypogonadism]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Cushing's syndrome|Hypercortisolism (Cushing's syndrome)]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Cushing's syndrome]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Multiple myeloma]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-
+| [[Celiac disease]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|-style="background:#efefef;"
+| [[Mastocytosis]]
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|
+|}
 ==References==
 {{Reflist|2}}