Sunday, January 6, 2013

Laboratory Tests for Osteoporosis

One of the best weapons we have for fighting osteoporosis is the availability of laboratory tests. Not only can they be used to identify the cause(s) of bone loss and to rule out other disease processes, but some of these tests can then be repeated to help monitor effectiveness of treatment. Any abnormal test results can then be used as therapeutic targets for improvement. On subsequent testing, positive changes will indicate that the therapies you and your doctor have initiated are making an impact--and that your health (and that of your bones) is improving. The 2004 Bone Health and Osteoporosis: A Report of the Surgeon General supports the use of lab tests to assess treatment effectiveness. I regularly use the information from lab tests to help me design nutritional support programs to optimize patients' bone health. These lab tests are an invaluable tool for reducing fracture risk.

The following are the "Basic Core" of laboratory tests that I find most helpful for diagnosing and managing osteoporosis:

    -  Comprehensive Metabolic Profile (CMP)
    -  Complete Blood Count (CBC)
    -  Vitamin D [25-hydroxyvitamin D or 25(OH)D]
    -  Urine calcium (24-hour)
    -  Celiac profile [Anti-tissue Transglutaminase Antibody (IgA-tTG); Total
                               Immunoglobulin A (Serum Total IgA); Anti-Gliadin Antibodies
                               IgG and IgA (IgG-AGA and IgA-AGA)
    -  Bone resorption marker (NTX, CTX, or DPD)
    -  Urine pH (first morning void)

The following are additional tests that may be appropriate depending on the patient:

    -  Protein electrophoresis
    -  PTH (parathyroid hormone)
    -  Calcitriol [1,25-dihydroxyvitamin D3 or 1,25(OH)2D3]
    -  Ionized serum calcium
    -  Osteocalcin
    -  TSH (thyroid function)
    -  Estrogen (estradiol)
    -  Homocysteine
    -  hs-CRP (high-sensitivity C-reactive protein)
    -  Erythrocyte Sedimentation Rate (ESR)
    -  Lipid peroxides
    -  8OH2dG
    -  Cortisol/DHEA
    -  Stool analysis
    -  Food allergy testing

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