Table 17.

Tests for Secondary Osteoporosis to Be Considered If There Is Clinical Suspicion

Serum thyrotropin

Erythrocyte sedimentation rate

Serum parathyroid hormone concentration for possible primary or secondary hyperparathyroidism

Tissue transglutaminase antibodies for suspected celiac disease

Urinary free cortisol or other tests for suspected adrenal hypersecretion

Acid-base studies

Serum tryptase, urine N-methylhistamine, or other tests for mastocytosis

Serum protein electrophoresis and free kappa and lambda light chains for suspected myeloma

Bone marrow aspiration and biopsy to look for marrow-based diseases

Undecalcified iliac crest bone biopsy with double tetracycline labeling

Recommended for patients with bone disease and renal failure to establish the correct diagnosis and direct management

May be helpful in the assessment of patients with the following:

Suspected osteomalacia or mastocytosis when laboratory test results are inconclusive

Fracture without major trauma despite normal or high bone density

Vitamin D-resistant osteomalacia and similar disorders to assess response to treatment

Unusual features that suggest a rare metabolic bone disease