Primary osteoporosis is associated with the normal loss of estrogen following the menopause as well as age. The average older woman with normal bone density loses about 13% of her bone density in 10 years or about 1.3% per year. However, there are a number of medical conditions and medications that can cause more rapid bone loss — the most common conditions are hyperparathyroidism, hyperthyroidism, vitamin D deficiency and celiac disease, and the most common medications are steroids and aromatase inhibitors. If you have low bone density, there may be other tests that your doctor will consider to determine if active bone loss is occurring. It is important to correct underlying causes before taking a treatment for osteoporosis.
What tests to expect
Your doctor will ask questions about your medical history and may prescribe blood or urine tests. This is especially important if you have had any broken bones. There are also tests that your doctor might request before determining what osteoporosis medicine to prescribe.
Standard blood panel
- Complete blood count (CBC)
- Chemistry levels (Calcium, renal function, phosphorus, and magnesium)
- Liver function tests
- Thyroid-stimulating hormone (TSH) level
- Serum 25(OH)D level
- Parathyroid hormone (PTH)
- Total testosterone and gonadotropin levels in younger men
Blood tests for certain situations
- Serum protein electrophoresis (SPEP), serum immunofixation, serum free light chains
- Tissue transglutaminase antibodies
- Iron and ferritin levels
- Homocysteine
- Tryptase
- Bone-specific Alkaline Phosphatase
Urine tests
- 24-hour urinary calcium
- Urine NTx (N-linked peptide of type 1 collagen)
Urine tests for certain situations
- Protein electrophoresis (UPEP)
- Urinary free cortisol level
- Urinary histamine
Factors and medical conditions that cause bone loss and increase fracture risk
Lifestyle factors |
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Alcohol > 3 drinks/day |
High salt intake |
Smoking (active or passive) |
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Low calcium intake |
Not enough physical activity |
Falling |
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Vitamin D insufficiency |
Immobilization |
Weight < 127 lbs |
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Excess vitamin A |
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Genetic |
Low sex hormone |
Gastrointestinal |
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Cystic fibrosis |
Androgen insensitivity |
Celiac disease |
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Ehlers-Danlos |
Anorexia nervosa and bulimia |
Gastric bypass |
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Gaucher’s disease |
Hyperprolactinemia |
GI surgery |
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Glycogen storage diseases |
Premature menopause |
Inflammatory bowel disease |
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Hemochromatosis |
Premature ovarian failure |
Malabsorption |
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Homocystinuria |
Athletic amenorrhea |
Pancreatic disease |
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Hypophosphatasia |
Primary biliary cirrhosis |
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Idiopathic hypercalciuria |
Endocrine |
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Marfan syndrome |
Adrenal insufficiency |
Central nervous system |
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Menkes steely hair syndrome |
Diabetes mellitus (Type 2) |
Epilepsy |
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Osteogenesis imperfecta |
Cushing’s syndrome |
Multiple sclerosis |
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Parent history of hip fracture |
Hyperparathyroidism |
Parkinson’s disease |
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Porphyria |
Central Adiposity |
Spinal cord injury |
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Riley-Day syndrome |
Thyrotoxicosis |
Stroke |
Other
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Hematologic
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Rheumatologic and autoimmune diseases |
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AIDS/HIV |
Multiple myeloma |
Ankylosing spondylitis |
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Alcoholism |
Thalassemia |
Lupus |
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Amyloidosis |
Leukemia and lymphomas |
Rheumatoid arthritis |
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Chronic metabolic acidosis |
Systemic mastocytosis |
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Chronic obstructive lung disease |
Hemophilia |
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Congestive heart failure |
Monoclonal gammopathies |
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Depression |
Sickle cell disease |
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End-stage renal disease |
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Hypercalciuria |
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Idiopathic Scoliosis |
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Muscular dystrophy |
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Chronic metabolic acidosis |
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Post-transplant bone disease |
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Sarcoidosis |
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Weight loss |
Reviewed: 10/31/19.
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