Cost effective evaluation to rule out causes of low bone mass
- Calcium (albumin), phosphorous, creatinine, CO 2 .
- Alkaline phosphatase.
- 25-hydroxy (OH) vitamin D.
- Testosterone (men).
- Thyroid-stimulating hormone (if clinically hyperthyroid).
- Celiac disease antibody testing (if Caucasian with symptoms or low 25-OH vitamin D level).
- Urine (24 hours) calcium, sodium, creatinine.
- Serum protein electrophoresis (if aged >50 years with abnormal complete blood count).
Pearl: A patient needs a calcium (corrected for albumin level) x phosphorous product of 24 to properly mineralize bone.
Approximately one-third of women and two-thirds of men will have an abnormality detected with this evaluation. Therefore, this cost effective evaluation is recommended in all patients with osteoporosis. A low Z-score suggests that an underlying secondary cause is even more likely to be present.
