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
Disease	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	Postmenopausal osteoporosis
	Serum bone–specific alkaline phosphatase^[3]	30 percent reduction	Treatment efficacy Increasing bone mineral density (BMD) Decreasing fracture risk
	Serum type 1 procollagen^[3]	30 percent reduction	Treatment efficacy Increasing bone mineral density (BMD) Decreasing fracture risk
Bone resorption markers	Urinary hydroxyproline^[4]	Elevated	Postmenopausal osteoporosis
	Urinary total pyridinoline (PYD)^[5]	Elevated	Postmenopausal osteoporosis Higher hip fracture risk
	Urinary free deoxypyridinoline (DPD)^[6]	Elevated	Higher bone resorption in postmenopausal female Lumbar spine osteoporosis
	Tartrate-resistant acid phosphatase 5b^[7]	Elevated	More severe osteoporosis in hip
	Bone sialoprotein (BSP)^[8]	Reduced after antiresorptive medicine	Decrease in bone mass loss Improving lumbar vertebrae BMD
	Urinary collagen type 1 cross-linked N-telopeptide (NTX)^[9]	Reduced to half	Increase in BMD Decrease in fracture risk
	Serum collagen type 1 cross-linked C-telopeptide (CTX)^[3]	30 percent reduction	Treatment efficacy Increasing bone mineral density (BMD) Decreasing fracture risk

References

↑ 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.
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[pmid20485912-1] 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.

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