Osteoporosis laboratory findings
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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 the diagnosis of osteoporosis; however, they may be used for differentiating primary versus secondary causes of the disease. Laboratory 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 tests for diagnosing secondary osteoporosis, which include but not limited to 24 hr serum calcium, serum protein electrophoresis, and serum thyroid hormones.
Laboratory findings
There is a limited role for laboratory tests in the diagnosis of osteoporosis; however, they may be used for differentiating primary versus secondary causes of the disease.
Abbreviations:
HGB: Hemoglobin, WBC: White blood cell, RBC: Red blood cell, IgM: Immunoglobulin M type
| 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 osteoporosis | - | - | - | - | ↑ | - | - | - | - | - | - | - | - | - | - | - | - | - |
| 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 |
Electrolyte and Biomarker 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
- A 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)
- An 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 thyroxine (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).
| Group | Test | Result | Outcome |
|---|---|---|---|
| Bone formation markers | Serum osteocalcin[2] | Elevated | |
| Serum bone–specific alkaline phosphatase[3] | 30 percent reduction |
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| Serum type 1 procollagen[3] | 30 percent reduction |
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| Bone resorption markers | Urinary hydroxyproline[4] | Elevated | |
| Urinary total pyridinoline (PYD)[5] | Elevated |
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| Urinary free deoxypyridinoline (DPD)[6] | Elevated |
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| Tartrate-resistant acid phosphatase 5b[7] | Elevated |
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| Bone sialoprotein (BSP)[8] | Reduced after antiresorptive medicine |
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| Urinary collagen type 1 cross-linked N-telopeptide (NTX)[9] | Reduced to half | ||
| Serum collagen type 1 cross-linked C-telopeptide (CTX)[3] | 30 percent reduction |
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