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Who needs a medical osteoporosis workup?

Tests included in the medical workup for osteoporosis

  • Vitamin D (25[OH]D) blood test
  • Ionized calcium test
  • Intact parathyroid hormone blood test (iPTH)
  • 24-hour urine calcium excretion test
  • Thyroid hormone function test (TSH)
  • Markers of bone resorption tests (NTx, Dpd, CTX)
  • Vertebral deformity assessment
  • Free cortisol test (blood or saliva)
  • DHEA test (blood or saliva)
  • C-reactive protein test (high sensitivity if possible).
  • Homocysteine test (plasma or serum)
  • Celiac disease and gluten sensitivity tests
  • Sex hormone tests

Here at the Center for Better Bones, we often say that it is difficult to solve a problem you do not fully understand. If you have a bone health problem — or if you or your doctor just suspect you might have a serious bone concern — an osteoporosis medical work-up is in order. As I always say, if it is serious enough for your physician to prescribe an osteoporosis drug, it is serious enough to merit medical testing to look for any hidden causes of the bone loss.

A good osteoporosis medical work-up can include a variety of tests such as the ones listed here. Over and over again we find that such simple medical tests can often reveal important causes of bone loss, such as inadequate vitamin D or a loss of calcium in the urine — problems that can be corrected, leading to improved bone health.

The medical osteoporosis work-up is so important that I have taken the time to write about 13 key tests that will help uncover any hidden medical issues that can cause or contribute to excessive bone loss. In addition, I also provide a discussion on understanding the results of these tests.

Everyone is an individual, and your reasons for bone loss are unique to you as well. Following my “Take Heart and Take Action” slogan, I suggest you print off this information on medical testing, read it, take it to your doctor, and check to see if these tests are appropriate for you.

Comments

May 25. 2010 10:37

I just want to thank you, Dr. Brown for the list of tests I should have done in my medical workup for Osteoporosis.  I will take this list to my Dr. and ask him if these tests are being done on me and for my health.  I was first diagnosed with severe Osteoporosis in 1997 and had to retire from my job in 1998 since I could no longer do what was required.  I actually was afraid to do anything for fear I would break.  since then for many years I was told I no longer had this, then in 2010 told I did have Osteoporosis again.  I had been getting bone density tests every 2 years.  Can this come and go as it chooses?  I am so confused about this.

Loretta Davis

May 25. 2010 15:04

Hi,
I am very grateful to find support through your website and blogs.
I never was tested on celiac disease. But eating wheat definetely makes me ill.I eat gluten-free.
I would like to learn why people with celiac disease are more prone to bone loss.
Thanks

Monika Munzinger

May 26. 2010 22:28

I was also tested for an additional condition, which it turns out I have--it is called MGUS, or Monoclonal Gammopathy of Undetermined Significance.  It is harmless, but in rare cases can develop into Multiple Myeloma, which is a blood/bone cancer.  My doctor thought it might explain my osteoporosis.

The test for it looks for an abnormal protein in the blood.

Anne Green

June 2. 2010 14:24

Dear Monika,

The quick answer to your question is that when someone with celiac eats gluten, the autoimmune reaction in the gut makes the lining of the intestines so inflamed that the person cannot absorb nutrients from food. As I've discussed in my articles on nutrition and bone health (see betterbones.com/bonenutrition), the bones are the storehouse of nutrients for the rest of the body, and when they're unable to get these nutrients from food because of the celiac-related inflammation, the body turns to the bones to replace those lost nutrients, and that's where osteoporosis develops. This in a nutshell is why it's essential for people with celiac disease to avoid gluten - even a little will trigger the autoimmune response. The NIH has a terrific web page describing the relationship at www.niams.nih.gov/health_info/bone/osteoporosis/conditions_behaviors/celiac.asp#b

Susan

June 2. 2010 16:25

Are there other conditions to be evaluated in a medical workup?
I've had my parathyroin checked and its ok and a celia test and it was normal.  My Nxt shows I'm still loosing bone  48.6.  I've had a stroke and am off estrogen and am on Plavix so I must watch my vit K intake.  Is there anything else to look for?  I exercise 5-6 days a week (walk 4 days, workout 2 days)

valeri jones

June 2. 2010 16:41

Valeri, there are many conditions (and medications for other conditions) that contribute to bone loss. Anticoagulants are among the medications that can lead to osteopenia or osteoporosis. Please see http://www.betterbones.com/osteoporosis/secondaryosteoporosis.aspx for a list of different factors that can be related.

Susan

June 9. 2010 16:27

My doctor says that Fosomax aids your bones in better absorption of calcium.  I don't remember reading that anywhere.  Can you reply?

Gail Bullard

June 9. 2010 16:37

Fosamax works by preventing bone breakdown, which leads to denser bone over time. Vitamin D and magnesium are what improve calcium absorption and utilization. Please see our articles here: http://www.betterbones.com/osteoporosis/osteoporosistreatment.aspx, here: http://www.betterbones.com/bonenutrition/vitamin-d.aspx, and here: http://www.betterbones.com/bonenutrition/magnesium.aspx

Susan

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