Osteoporosis laboratory findings

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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.

Lab tests

Baseline tests

• 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

• 24-hr serum calcium
• 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

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.