Tests for Osteoporosis Diagnosis


You've just been diagnosed with osteoporosis and you aren't sure what other tests to have besides the DXA. It's a good idea to have blood and urine tests to check for mineral and vitamin metabolism problems, among others, and to check for secondary medical causes of bone loss and medication causes as well.

Here's a list of tests you can have your doctor order if you want to look into the various causes of osteoporosis besides the primary causes, like hormone depletion from menopause, after your DXA and Vertebral Fracture Assessment test.

Blood and Urine Tests for Osteoporosis:

Blood calcium test


24-hour urine calcium

Vitamin D

Protein electrophoresis

Bone formation markers

Parathyroid hormone (PTH)

Alkaline phosphatase (ALP)

Bone resorption markers

Thyroid   (T4 )


Celiac blood test

Follicle-stimulating hormone (FSH)

Estradiol (Estrogen level)


Free cortisol

C-reactive hormone

Homocysteine  [1 & 3]

  • Blood Calcium levels are elevated when you have other bone diseases.
  • Vitamin D, when low can lead to decreased calcium absorption.
  • Parathyroid hormone is used to check for hyperparathyroidism.
  • Thyroid tests check for thyroid disorder.
  • Follicle-stimulating hormone is used to check menopause status.
  • Testosterone is used in men to check for deficiencies.
  • Protein electrophoresis checks for proteins produced by certain cancers that cause bone resorption.
  • Alkaline phosphatase checks for elevated levels that may cause bone loss.
  • Phosphorus to help treat disorders with calcium and phosphorus imbalances.
  • Estradiol for estrogen levels.
  • 24-hour urine calcium tells you how much calcium is lost through urine.
  • Bone formation markers tests that measure how much bone/collagen you are building.
  • Bone resorption markers tests that measure how much bone/collagen you are losing.
  • Celiac test for gluten allergy which can cause bone loss if untreated.
  • DHEA evaluates the function of the adrenal glands.
  • Free cortisol measures cortisol hormone which may relate to adrenal and pituitary gland problems.
  • C-reactive hormone tests for inflammatory diseases, e.g. arthritis, IBS.
  • Homocysteine elevated levels may indicate atherosclerosis [1 & 3]

Formation markers:

Bone-specific alkaline phosphatase (Bone ALP)

Procollagen type I N propeptide (PINP)

Alkaline phosphatase (ALP)

Procollagen type I C propeptide (PICP)

Osteocalcin (bone gla-protein) (OC)


Resorption Markers:

N-telopeptide (N-terminal telopeptide of type 1 collagen) (NTx)

Free Lysyl-pyridinoline (deoxypyridinoline) (DPD)

C-telopeptide (C-terminal telopeptide of type 1 collagen) (CTx)

Tartrate-resistant acid phosphatase (TRACP)

Pyridinoline (PYD)

Hydroxy-proline (HYP) [2]

Once you've had these tests done, you'll have a better idea what's causing your bone loss, and will have options for treatment. Most insurance companies cover these tests, but check first for coverage details, to be sure. The more information you have about your bone loss disorder the easier it is to treat.

If you find that you are not within the normal range on any of these tests, your doctor may do further testing, and treat the medical problems that are detected.   Treating these disorders seperately should help you to regain some of your lost bone mineral density (BMD).


  1. Lab Tests Onlinehttp://www.labtestsonline.org/understanding/conditions/osteoporosis-2.html (retrieved June 26, 2010)

  1. University of Washington on bone markers http://courses.washington.edu/bonephys/opmark.html (retrieved June 26, 2010)

  1. National Institutes of Health http://www.niams.nih.gov/health_info/bone/osteoporosis/diagnosis.asp#e  (retrieved June 26, 2010)