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.
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 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 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);
- Urinary collagen type 1 cross-linked N-telopeptide (NTX);
- For urinary excretion of NTX, an approximately 50 percent decline is predictive of improvement in bone mineral density (BMD) and fracture risk
- ●In the control arm of a trial of 236 postmenopausal women randomly assigned to postmenopausal hormone therapy and calcium versus calcium alone (control), women with the highest quartile value of N-telopeptide of type 1 collagen (NTX) throughout the study had the greatest bone loss compared with women with the lowest quartile value [17].
- Serum collagen type 1 cross-linked C-telopeptide (CTX)
- serum CTX, P1NP, and BALP, a 30 percent decline is similarly predictive
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.
- ↑ 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 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.