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Tests to Determine Secondary Causes of Bone Loss

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Tests to determine secondary causes of bone loss
Primary osteoporosis results from aging and the normal loss of estrogen following menopause. The average 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 medical conditions are hyperparathyroidism, hyperthyroidism, vitamin D deficiency and Celiac disease. The most common medications are steroids and aromatase inhibitors. If you have low bone density, there may be other tests that your doctor will order to determine if active bone loss is occurring. Correcting the underlying cause of bone loss is important 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

 

 

 

 

 

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