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.
Electrolyte and Biomarker Studies
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 |
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
| Group | Test | Result | Outcome |
|---|---|---|---|
| Bone formation markers | Serum osteocalcin[1] | Elevated | |
| Serum bone–specific alkaline phosphatase[2] | 30 percent reduction |
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| Serum type 1 procollagen[2] | 30 percent reduction |
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| Bone resorption markers | Urinary hydroxyproline[3] | Elevated | |
| Urinary total pyridinoline (PYD)[4] | Elevated |
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| Urinary free deoxypyridinoline (DPD)[5] | Elevated |
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| Tartrate-resistant acid phosphatase 5b[6] | Elevated |
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| Bone sialoprotein (BSP)[7] | Reduced after antiresorptive medicine |
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| Urinary collagen type 1 cross-linked N-telopeptide (NTX)[8] | Reduced to half | ||
| Serum collagen type 1 cross-linked C-telopeptide (CTX)[2] | 30 percent reduction |
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References