Osteoporosis laboratory findings: Difference between revisions

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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.  
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" align="center"
{| 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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! style="background:#efefef;" |Osteoporosis related disease
! style="background:#efefef;" |Osteoporosis related disease
|-
|-
| rowspan="3"|[[Bone]] formation markers
| rowspan="3" |[[Bone]] formation markers
| Serum [[osteocalcin]]
| Serum [[osteocalcin]]
| Elevated
| Elevated
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| Treatment efficacy, increasing [[Bone mineral density|bone mineral density (BMD)]] and decreasing [[fracture]] risk
| Treatment efficacy, increasing [[Bone mineral density|bone mineral density (BMD)]] and decreasing [[fracture]] risk
|-
|-
| rowspan="7"|[[Bone]] resorption markers
| rowspan="7" |[[Bone]] resorption markers
| Urinary [[hydroxyproline]]
| Urinary [[hydroxyproline]]
| Elevated
| Elevated
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| Treatment efficacy <br> Increasing [[Bone mineral density|bone mineral density (BMD)]] <br> Decreasing [[fracture]] risk
| Treatment efficacy <br> Increasing [[Bone mineral density|bone mineral density (BMD)]] <br> 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]] 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" />
=== Electrolyte and Bio-marker 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]]


===Electrolyte and Bio-marker Studies===
Reduced number of all cell types ([[RBC]], [[WBC]], and [[platelet]]) may reveal [[aplasia]] associated [[osteoporosis]]


==== [[Complete blood count|Complete blood count (CBC)]] ====
==== Serum calcium level and/or 24-hr serum calcium ====
* Reduced [[hemoglobin]] level may reveal [[sickle cell anemia]], [[multiple myeloma]], or [[alcoholism]] associated [[osteoporosis]]
Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] 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]] ====
[[hypocalcemia]] may reflect [[vitamin D deficiency]] associated [[osteoporosis]]
* Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] associated [[osteoporosis]]
* [[hypocalcemia]] may reflect [[vitamin D deficiency]] associated [[osteoporosis]]


==== Serum [[phosphate]] level ====
==== Serum phosphate level ====
* Reduced serum [[phosphate]] level may reveal '''[[hypophosphatemic rickets]]''' associated [[osteoporosis]]
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 [[phosphate]] level may reveal [[vitamin D deficiency]], or [[chronic kidney disease]] associated [[osteoporosis]]
* Elevated serum [[alkaline phosphatase]] level may reveal [[postmenopausal]] or destructive [[bone]] [[diseases]] (e.g., [[bone tumors]]) associated [[osteoporosis]]


==== Serum [[Vitamin D|25-(OH)-vitamin D]] level ====
==== Serum alkaline phosphatase level ====
* Reduced serum [[Vitamin D|25-(OH)-vitamin D]] level may reveal [[vitamin D deficiency]] associated [[osteoporosis]]
Elevated serum [[alkaline phosphatase]] level may reveal [[postmenopausal]] or destructive [[bone]] [[diseases]] (e.g., [[bone tumors]]) associated [[osteoporosis]]


==== Serum [[creatinine]] level ====
==== Serum 25-(OH)-vitamin D level ====
* Elevated serum [[creatinine]] level may reflect [[chronic renal failure]], which leads to [[renal osteodystrophy]]
Reduced serum [[Vitamin D|25-(OH)-vitamin D]] level may reveal [[vitamin D deficiency]] associated [[osteoporosis]]


==== Serum [[magnesium]] level ====
==== Serum creatinine level ====
* Reduced [[magnesium]] level may reflect [[vitamin D deficiency]] associated [[osteoporosis]]
Elevated serum [[creatinine]] level may reflect [[chronic renal failure]], which leads to [[renal osteodystrophy]]


==== Serum [[iron]] and [[ferritin]] levels ====
==== Serum magnesium level ====
* Elevated [[iron]] and [[ferritin]] serum levels may reveal [[hemochromatosis]] associated [[osteoporosis]]
Reduced [[magnesium]] level may reflect [[vitamin D deficiency]] 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]] ====
==== Serum iron and ferritin levels ====
* Reduced [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]] and elevated [[Thyroxin|free thyroxin (T4)]] may reveal [[hyperthyroidism]] associated [[osteoporosis]]
Elevated [[iron]] and [[ferritin]] serum levels may reveal [[hemochromatosis]] associated [[osteoporosis]]


==== Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level ====
====Liver function tests (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and bilirubin)====
* Elevated Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level may reflect [[hyperparathyroidism]] associated [[osteoporosis]]
Elevated level of [[liver function tests]] may reflect [[liver diseases]] (e.g., [[alcoholism]]) 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 ====
==== Thyroid function tests ====
* Reduced [[testosterone]] and [[gonadotropin]] levels in men may reveal [[hypogonadism]] associated [[osteoporosis]]
Reduced [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]] and elevated [[Thyroxin|free thyroxin (T4)]] may reveal [[hyperthyroidism]] associated [[osteoporosis]]


==== Urine free [[cortisol]] level ====
==== Serum parathyroid hormone (PTH) level ====
* Elevated urine free [[cortisol]] level may reflect [[Cushing's syndrome|hypercortisolism (Cushing's syndrome)]] associated [[osteoporosis]]
Elevated Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level may reflect [[hyperparathyroidism]] associated [[osteoporosis]]


==== Other bio-markers tests ====
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>
* [[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]])
==== Testosterone and gonadotropin levels ====
* [[Anti-gliadin antibodies|Anti-gliadin]] and anti-endomysial antibodies (for identifying [[celiac disease]] associated [[osteoporosis]])
Reduced [[testosterone]] and [[gonadotropin]] levels in men may reveal [[hypogonadism]] associated [[osteoporosis]]
* Serum [[tryptase]] and urine N-methylhistamine (for identifying [[mastocytosis]] associated [[osteoporosis]])


=== Bone turnover markers ===
==== Urine free cortisol level ====
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:
Elevated urine free [[cortisol]] level may reflect [[Cushing's syndrome|hypercortisolism (Cushing's syndrome)]] associated [[osteoporosis]]


===== [[Bone]] formation markers =====
==== Other bio-markers tests ====
* 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>
[[Dexamethasone suppression test|Over night dexamethasone suppression test]] (for identifying [[cushing's syndrome]] associated [[osteoporosis]])
* 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 =====
[[Serum protein electrophoresis]] (SPEP) and urine [[protein electrophoresis]] (for identifying [[multiple myeloma]] associated [[osteoporosis]])
* 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" />


[[Anti-gliadin antibodies|Anti-gliadin]] and anti-endomysial antibodies (for identifying [[celiac disease]] associated [[osteoporosis]])


{|border="1" cellpadding="2"
Serum [[tryptase]] and urine N-methylhistamine (for identifying [[mastocytosis]] associated [[osteoporosis]])
|-style="background:LightGrey"
{| border="1" cellpadding="2"
|- style="background:LightGrey"
! rowspan="2" |Disease  
! rowspan="2" |Disease  
! colspan="18" |Electrolyte and Bio-marker Studies
! colspan="18" |Electrolyte and Bio-marker Studies
|-style="background:LightGrey"
|- style="background:LightGrey"
| [[Complete blood count|Complete blood count (CBC)]]
| [[Complete blood count|Complete blood count (CBC)]]
| Serum [[calcium]] level  
| Serum [[calcium]] level  
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| [[Thyroid function tests]]
| [[Thyroid function tests]]
| Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level
| Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level
| Serum [[Testosterone]] and [[gonadotropin]] level
| Serum [[Testosterone]]/[[gonadotropin]] level
| Urine free [[cortisol]] level
| Urine free [[cortisol]] level
| [[Dexamethasone suppression test|Over night dexamethasone suppression test]]
| [[Dexamethasone suppression test|Over night dexamethasone suppression test]]
| [[Serum protein electrophoresis]] (SPEP) <br> Urine [[protein electrophoresis]]
| [[Serum protein electrophoresis]]/ Urine [[protein electrophoresis]]
| [[Anti-gliadin antibodies|Anti-gliadin]] <br> Anti-endomysial antibodies
| [[Anti-gliadin antibodies|Anti-gliadin]] <br> Anti-endomysial antibodies
| Serum [[tryptase]] <br> Urine N-methylhistamine
| Serum [[tryptase]] <br> Urine N-methylhistamine
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|-style="background:#efefef;"
|- style="background:#efefef;"
| [[Vitamin D deficiency]]
| [[Vitamin D deficiency]]
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| ↓
| ↓
| ↓
| ↑
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| [[Sickle cell anemia]]  
| [[Sickle cell anemia]]  
| ↓[[Hemoglobin|HGB]]
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| ↑
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|-style="background:#efefef;"
|- style="background:#efefef;"
| [[Multiple myeloma]]
| [[Multiple myeloma]]
| ↓[[Hemoglobin|HGB]]
| ↑
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| ↑ [[IgM]]
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| [[Leukemia]]/[[lymphoma]]  
| [[Leukemia]]/[[lymphoma]]  
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| ↑[[WBC]]
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|-style="background:#efefef;"
|- style="background:#efefef;"
| [[Alcoholism]]
| [[Alcoholism]]
| ↓[[Hemoglobin|HGB]]
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| [[Aplasia]]  
| [[Aplasia]]  
| ↓[[Red blood cell|RBC]], ↓[[WBC]], ↓[[Platelet|PLT]]
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|-style="background:#efefef;"
|- style="background:#efefef;"
| [[Malignancy]]
| [[Malignancy]]
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| ↑↑↑
| ↑↑↑
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| [[Hyperparathyroidism]]
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|-style="background:#efefef;"
|- style="background:#efefef;"
| [[Hypophosphatemic rickets]]  
| [[Hypophosphatemic rickets]]  
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| ↓↓
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| [[Chronic kidney disease]]  
| [[Chronic kidney disease]]  
| ↓[[Hemoglobin|HGB]]
| ↑↑
| ↑↑
| ↓↓
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| ↓
| ↑
| ↑↑↑
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|-style="background:#efefef;"
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| Destructive [[bone]] [[diseases]] (e.g., [[bone tumors]])
| Destructive [[bone]] [[diseases]] (e.g., [[bone tumors]])
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Revision as of 16:00, 15 August 2017

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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 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

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

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

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)

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.[9]

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)

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 ↑
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

References

  1. ↑ 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.
  2. ↑ 2.0 2.1 2.2 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.

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