Osteoporosis laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
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. [[Laboratory techniques|Lab tests]] for the [[diagnosis]] of [[osteoporosis]] include some baseline tests like [[complete blood count | 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]]. [[Laboratory techniques|Lab tests]] for the [[diagnosis]] of [[osteoporosis]] include some baseline tests like [[Complete blood count|complete blood count (CBC)]], [[Calcium|serum calcium]], [[phosphate]], [[alkaline phosphatase]], and [[Vitamin D|25-(OH)-vitamin D]]. There are also tests for diagnosing secondary [[osteoporosis]], which include 24 hr [[Calcium|serum calcium]], serum [[protein electrophoresis]], and serum [[Thyroid hormone|thyroid hormones]]. | ||
==Laboratory findings== | ==Laboratory findings== | ||
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! style="background:#efefef;" |Osteoporosis related disease | ! style="background:#efefef;" |Osteoporosis related disease | ||
|- | |- | ||
| rowspan="3" | | | 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" | | | rowspan="7" |'''Bone resorption markers''' | ||
| Urinary [[hydroxyproline]] | | Urinary [[hydroxyproline]] | ||
| Elevated | | Elevated | ||
Line 35: | Line 35: | ||
| Urinary total pyridinoline (PYD) | | Urinary total pyridinoline (PYD) | ||
| Elevated | | Elevated | ||
| [[Postmenopausal]] [[osteoporosis]]<br> Higher [[hip]] [[fracture]] risk | | [[Postmenopausal]] [[osteoporosis]]<br>Higher [[hip]] [[fracture]] risk | ||
|- | |- | ||
| Urinary free deoxypyridinoline (DPD) | | Urinary free deoxypyridinoline (DPD) | ||
| Elevated | | Elevated | ||
| Higher bone resorption in [[postmenopausal]] female <br> [[Lumbar spine]] [[osteoporosis]] | | Higher bone resorption in [[postmenopausal]] female <br>[[Lumbar spine]] [[osteoporosis]] | ||
|- | |- | ||
| [[Tartrate resistant acid phosphatase|Tartrate-resistant acid phosphatase 5b]] | | [[Tartrate resistant acid phosphatase|Tartrate-resistant acid phosphatase 5b]] | ||
Line 45: | Line 45: | ||
| More severe [[osteoporosis]] in [[hip]] | | More severe [[osteoporosis]] in [[hip]] | ||
|- | |- | ||
| [[Bone sialoprotein | | [[Bone sialoprotein|Bone sialoprotein (BSP)]] | ||
| Reduced after antiresorptive medicine | | Reduced after antiresorptive medicine | ||
| Decrease in [[bone]] mass loss <br> Improving [[lumbar vertebrae]] [[Bone mineral density|BMD]] | | Decrease in [[bone]] mass loss <br>Improving [[lumbar vertebrae]] [[Bone mineral density|BMD]] | ||
|- | |- | ||
| Urinary [[collagen]] type 1 cross-linked N-telopeptide (NTX) | | Urinary [[collagen]] type 1 cross-linked N-telopeptide (NTX) | ||
| Reduced to half | | Reduced to half | ||
| Increase in [[Bone mineral density|BMD]] <br> Decrease in [[fracture]] risk | | Increase in [[Bone mineral density|BMD]] <br>Decrease in [[fracture]] risk | ||
|- | |- | ||
| Serum [[collagen]] type 1 cross-linked C-telopeptide (CTX) | | Serum [[collagen]] type 1 cross-linked C-telopeptide (CTX) | ||
| 30 percent reduction | | 30 percent reduction | ||
| 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 === | === 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: | 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 ===== | ===== Bone formation markers ===== | ||
* Serum [[osteocalcin]] | * 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]] | * 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]] | * 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 ===== | ===== Bone resorption markers ===== | ||
* Urinary [[hydroxyproline]] | * 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) | * 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) | * 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]] | * [[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) | *[[Bone sialoprotein]] (BSP): Reduced levels after antiresorptive medicines reflect the decrease in [[Bone loss|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) | *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) | * 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 === | === Electrolyte and Bio-marker Studies === | ||
==== Complete blood count (CBC) ==== | ==== Complete blood count (CBC) ==== | ||
Reduced [[hemoglobin]] level may reveal [[sickle cell anemia]], [[multiple myeloma]], or [[alcoholism]] associated [[osteoporosis]] | 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]] | 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]] | Reduced number of all cell types ([[RBC]], [[WBC]], and [[platelet]]) may reveal [[aplasia]] associated [[osteoporosis]]. | ||
==== Serum calcium level and/or 24-hr serum calcium ==== | ==== Serum calcium level and/or 24-hr serum calcium ==== | ||
Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] associated [[osteoporosis]] | Severe [[hypercalcemia]] may reflect [[malignancy]] or [[hyperparathyroidism]] associated [[osteoporosis]]. | ||
[[hypocalcemia]] may reflect [[vitamin D deficiency]] 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]] | Elevated serum [[phosphate]] level may reveal [[vitamin D deficiency]], or [[chronic kidney disease]] associated [[osteoporosis]]. | ||
==== Serum alkaline phosphatase level ==== | ==== Serum alkaline phosphatase level ==== | ||
Elevated serum [[alkaline phosphatase]] level may reveal [[postmenopausal]] or destructive [[bone]] [[diseases]] (e.g., [[bone tumors]]) associated [[osteoporosis]] | Elevated serum [[alkaline phosphatase]] level may reveal [[postmenopausal]] or destructive [[bone]] [[diseases]] (e.g., [[bone tumors]]) associated [[osteoporosis]]. | ||
==== Serum 25-(OH)-vitamin D level ==== | ==== Serum 25-(OH)-vitamin D level ==== | ||
Reduced serum [[Vitamin D|25-(OH)-vitamin D]] level may reveal [[vitamin D deficiency]] associated [[osteoporosis]] | Reduced serum [[Vitamin D|25-(OH)-vitamin D]] level may reveal [[vitamin D deficiency]] associated [[osteoporosis]]. | ||
==== Serum creatinine level ==== | ==== Serum creatinine level ==== | ||
Elevated serum [[creatinine]] level may reflect [[chronic renal failure]], which leads to [[renal osteodystrophy]] | Elevated serum [[creatinine]] level may reflect [[chronic renal failure]], which leads to [[renal osteodystrophy]]. | ||
==== Serum magnesium level ==== | ==== Serum magnesium level ==== | ||
Reduced [[magnesium]] level may reflect [[vitamin D deficiency]] associated [[osteoporosis]] | Reduced [[magnesium]] level may reflect [[vitamin D deficiency]] associated [[osteoporosis]]. | ||
==== Serum iron and ferritin levels ==== | ==== Serum iron and ferritin levels ==== | ||
Elevated [[iron]] and [[ferritin]] serum levels may reveal [[hemochromatosis]] associated [[osteoporosis]] | Elevated [[iron]] and [[ferritin]] serum levels may reveal [[hemochromatosis]] associated [[osteoporosis]]. | ||
====Liver function tests (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and bilirubin)==== | ====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]] | Elevated level of [[liver function tests]] may reflect [[liver diseases]] (e.g., [[alcoholism]]) associated [[osteoporosis]]. | ||
==== Thyroid function tests ==== | ==== Thyroid function tests ==== | ||
Reduced [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]] and elevated [[Thyroxin|free thyroxin (T4)]] may reveal [[hyperthyroidism]] associated [[osteoporosis]] | Reduced [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]] and elevated [[Thyroxin|free thyroxin (T4)]] may reveal [[hyperthyroidism]] associated [[osteoporosis]]. | ||
==== Serum parathyroid hormone (PTH) level ==== | ==== Serum parathyroid hormone (PTH) level ==== | ||
Elevated Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level may reflect [[hyperparathyroidism]] associated [[osteoporosis]] | Elevated Serum [[Parathyroid hormone|parathyroid hormone (PTH)]] level may reflect [[hyperparathyroidism]] 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> | 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 ==== | ==== Testosterone and gonadotropin levels ==== | ||
Reduced [[testosterone]] and [[gonadotropin]] levels in men may reveal [[hypogonadism]] associated [[osteoporosis]] | Reduced [[testosterone]] and [[gonadotropin]] levels in men may reveal [[hypogonadism]] associated [[osteoporosis]]. | ||
==== Urine free cortisol level ==== | ==== Urine free cortisol level ==== | ||
Elevated urine free [[cortisol]] level may reflect [[Cushing's syndrome|hypercortisolism (Cushing's syndrome)]] associated [[osteoporosis]] | Elevated urine free [[cortisol]] level may reflect [[Cushing's syndrome|hypercortisolism (Cushing's syndrome)]] associated [[osteoporosis]]. | ||
==== Other bio-markers tests ==== | ==== Other bio-markers tests ==== | ||
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|-style="background:#efefef;" | |- style="background:#efefef;" | ||
| [[Chronic kidney disease]] | | [[Chronic kidney disease]] | ||
| ↓[[Hemoglobin|HGB]] | | ↓[[Hemoglobin|HGB]] | ||
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|-style="background:#efefef;" | |- style="background:#efefef;" | ||
| [[Liver diseases]] | | [[Liver diseases]] | ||
| ↓[[Hemoglobin|HGB]] | | ↓[[Hemoglobin|HGB]] |
Revision as of 16:54, 17 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
- Serum osteocalcin: Elevated serum osteocalcin level in postmenopausal women reveal primary osteoporosis, also lower BMD in femoral neck and lumbar vertebrae[1]
- Serum bone–specific alkaline phosphatase: 30 percent reduction may reflect treatment efficacy, increasing bone mineral density (BMD) and decreasing fracture risk[2]
- Serum type 1 procollagen: 30 percent reduction may reflect treatment efficacy, increasing BMD and decreasing fracture risk[2]
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[3]
- Urinary total pyridinoline (PYD): Elevated level may reflect higher bone resorption in postmenopausal female with lumbar spine osteoporosis[4]
- Urinary free deoxypyridinoline (DPD): Elevated levels in postmenopausal female correspond with osteoporosis and higher hip fracture risk[5]
- Tartrate-resistant acid phosphatase 5b: Elevated levels may reflect more severe osteoporosis in hip[6]
- Bone sialoprotein (BSP): Reduced levels after antiresorptive medicines reflect the decrease in bone mass loss and improving lumbar vertebrae BMD[7]
- Urinary collagen type 1 cross-linked N-telopeptide (NTX): Reduced level to half of the original measure may reveal increase in BMD and decrease in fracture risk[8]
- Serum collagen type 1 cross-linked C-telopeptide (CTX): Reduced level for 30 percent may reflect treatment efficacy, increasing bone mineral density (BMD) and decreasing fracture risk[2]
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)
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.