Routine Lab Investigations in Osteoporosis

Routine Lab Investigations in Osteoporosis

We know by now that we need to eat the right foods, need to work out, and do stuff that is healthy for us. Because maintaining good health does not happen by accident, it requires work and smart lifestyle choices. But sometimes when we wake up at 6 am to hit the gym before work or shunning the donuts in breakfast, it’s easy to lose sight of for what are we doing all these. So here are some top articles choices that can keep you motivated to lead a healthy lifestyle and keep diseases at bay.

Routine Lab Investigations in Osteoporosis

There is no specific algorithm, which can guide in diagnosis as well as management or treatment of osteoporosis, when a patient comes with osteoporosis. The routine laboratory investigations done in case of suspected osteoporosis include complete blood count, measurement of serum calcium level, 24 hour urine calcium estimation, renal function tests and hepatic function tests. These tests can be helpful in determining causes (secondary causes) of low bone mass, especially in selected cases of women with fractures or very low Z-score.

An increase (higher than normal) serum calcium level is indicative of malignancy or hyperparathyroidism and lower than normal serum calcium level is indicative of malnutrition or osteomalacia. If there is an increase serum calcium (hypercalcemia) level, estimation of parathyroid hormone level can differentiate hyperparathyroidism from malignancy. Increased parathyroid hormone level in presence of hypercalcemia indicates hyperparathyroidism and lower parathyroid hormone level in presence of hypercalcemia indicate malignancy. Also, high PTHrP (parathyroid hormone-related peptide) level in presence of hypercalcemia indicate humoral hypercalcemia of malignancy.

Low urine calcium (less than 50 mg in 24 hours) is suggestive of osteomalacia, malnutrition, or malabsorption and a high urine calcium (more than 300 mg in 24 hours) or hypercalciuria, must be investigated further. Hypercalciuria may be due to

  1. Due to leak of calcium from kidneys, and commonly seen in males with osteoporosis.

2.  Cancers of blood or blood systems or conditions associated with excessive bone turnover such as Paget’s disease, hyperparathyroidism, and hyperthyroidism.

3.   In absorptive hypercalciuria, which is generally idiopathic (unknown cause) or may be due to increase of 1, 25 (OH)2D in granulomatous disease.

People with fracture due to osteoporosis or bone mass in the range of osteoporosis should check serum 25(OH)D level, because the requirement of vitamin D to reach target level of serum 25(OH)D is different in different individuals. Appropriate intake vitamin D is necessary for optimal treatment of osteoporosis. Measurement of TSH is required to check thyroid status.

If there is any suspicion of Cushing’s syndrome, a fasting serum cortisol level should be measured after overnight dexamethasone. Serum albumin, cholesterol, (complete blood count) etc. should be checked malabsorption, malnutrition or any bowel disease is suspected.

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