Who needs a medical work-up to find the causes of their osteoporosis?

Here at the Center for Better Bones, we often say that it is difficult to solve a problem you do not fully understand.Osteoporosis does not happen “just because” — there are always underlying causes of osteoporosis. Some of these causes are lifestyle-related, but others can be undetected health problems of which the bone loss is just a symptom.

If you have a bone health problem — or if you or your doctor simply suspect you might have a serious bone concern — an osteoporosis medical work-up of tests is in order to look for the causes of your bone loss.

Step #1: Find out what is happening — are you really losing bone?

When there is any type of bone health concern, an attempt should be made first to understand exactly what is happening with the bones.

Questions we might ask here include:

• What is your bone density compared to young folks of your same sex?
• What is your bone density compared to folks of the same sex and same age?
• Are you underweight with small bones, and thus more likely to have a low bone density reading?
• Is your bone loss ongoing?
• If you’re female, is your bone loss related to the transitions of perimenopause and early postmenopause?
• Do you have multiple osteoporosis risk factors?
• Have you experienced any fractures?
• Overall, is there a real problem?

Step #2: Find out why it is happening — what’s the cause of your bone loss?

After these questions have been answered and it has been determined that there is a real concern, then the next step is to undertake medical testing to uncover the underlying causes of any real problems. A good osteoporosis medical work-up can include a variety of tests such as the ones listed below. Background information for these tests and their interpretation is provided in my two articles, The diagnostic tests to find what causes osteoporosis and Understanding your test results.

Tests included in the medical work-up 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)
• Sex hormone testing

The final step in this process should be clear: once you know that you’re losing bone and have found out why you’re losing bone, you can stop the bone loss by addressing the underlying health problem that’s costing you bone! In some cases, it may be something as simple as improving your vitamin D status, either by spending more time in the sun or using vitamin D supplements, or both if needed. Other health concerns might need more complicated solutions, requiring further discussion with your healthcare provider to help you understand what your test results mean.