Indications directory

Basic evaluations:

Urine/EDTA-plasma:

Pyridinolines in the 2^nd morning urine, calcium and phosphate in the spontaneous urine or in the 24-hour urine, cross-laps (CTX) in the EDTA-plasma

Clinical chemistry:

Full blood count, ESR, CRP, alkaline phosphatase, AP-isoenzymes, calcium, phosphate, creatinine, GOT, GPT, gamma-GT

Endocrinology:

In women: Estradiol, FSH, LH

In men: Testosterone, LH, FSH

Molecular-genetic evaluations:

COL1A1-gene mutation (collagen-type 1)

VDR-gene mutation (Vitamin D-receptor-protein)

ER-1-gene mutation (Estrogen-receptor-1-protein)

Differential diagnosis of secondary osteoporosis:

• Plasmocytoma: Immunofixation, if necessary also in spontaneous urine
• Cushing syndrome: Cortisol day profile or dexamethasone overnight test (please refer to function tests)
• Hyperthyroidism: TSH, FT3, FT4
• Hyperparathyroidism: Parathyroid hormone (EDTA-plasma/serum), calcium
• Kidney failure: Parathyroid hormone (EDTA-plasma/serum), calcium, 25-hydroxy-vitamin D and 1,25-dihydroxy-vitamin D3 (serum)
• Malabsorption syndrome: Iron, ferritin, 25-hydroxy-vitamin D (serum), PTT, INR (citrate-plasma), elastase (stool), xylose-test
• Paget’s disease: See there
• Bone metastasis: Imaging, if necessary tumor markers
• Mastocytosis

Other causes:

Acromegaly, vitamin D intoxication, immobilization, long-term heparin therapy, diabetes, liver diseases. In case of unclear osteoporosis, also consider non-classical type of Celiac disease/sprue (see there).

Check on progress (every 3-6 months):

Urine:

Pyridinolines in the 2^nd morning urine, calcium and phosphate in spontaneous urine or in 24-hour urine.

Clinical chemistry: Alkaline phosphatase, AP-isoenzymes

Endocrinology:

Vitamin D; in women: Estradiol