fbpx

Tests to Determine Secondary Causes of Bone Loss

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

Alcohol > 3 drinks/day

High salt intake

Smoking (active or passive)

Low calcium intake

Not enough physical activity

Falling

Vitamin D insufficiency

Immobilization

Weight < 127 lbs

Excess vitamin A

   

 

Genetic

Low sex hormone

Gastrointestinal

Cystic fibrosis

Androgen insensitivity

Celiac disease

Ehlers-Danlos

Anorexia nervosa and bulimia

Gastric bypass

Gaucher’s disease

Hyperprolactinemia

GI surgery

Glycogen storage diseases

Premature menopause

Inflammatory bowel disease

Hemochromatosis

Premature ovarian failure

Malabsorption

Homocystinuria

Athletic amenorrhea

Pancreatic disease

Hypophosphatasia

 

Primary biliary cirrhosis

Idiopathic hypercalciuria

Endocrine

 

Marfan syndrome

Adrenal insufficiency

Central nervous system

Menkes steely hair syndrome

Diabetes mellitus (Type 2)

Epilepsy

Osteogenesis imperfecta

Cushing’s syndrome

Multiple sclerosis

Parent history of hip fracture

Hyperparathyroidism

Parkinson’s disease

Porphyria

Central Adiposity

Spinal cord injury

Riley-Day syndrome

Thyrotoxicosis

Stroke

 

Other conditions

Hematologic disorders

Rheumatologic and autoimmune diseases

AIDS/HIV

Multiple myeloma

Ankylosing spondylitis

Alcoholism

Thalassemia

Lupus

Amyloidosis

Leukemia and lymphomas

Rheumatoid arthritis

Chronic metabolic acidosis

Systemic mastocytosis

 

Chronic obstructive lung disease

Hemophilia

 

Congestive heart failure

Monoclonal gammopathies

 

Depression

Sickle cell disease

 

End-stage renal disease

 

 

Hypercalciuria

 

 

Idiopathic Scoliosis

   

Muscular dystrophy

   

Chronic metabolic acidosis

   

Post-transplant bone disease

   

Sarcoidosis

   

Weight loss

   

 

Popular Articles