From the Guidelines
The workup for secondary osteoporosis should begin with a comprehensive medical history and physical examination, followed by laboratory testing to identify underlying causes, as recommended by the study published in Clinical Infectious Diseases in 2010 1. The initial step in the workup for secondary osteoporosis is to perform a thorough history and physical examination with a focus on secondary causes of osteoporosis.
- This should be followed by laboratory tests, including:
- Complete blood count
- Routine blood chemistry tests
- Determination of creatinine, blood urea nitrogen, total calcium, phosphate, albumin, and alkaline phosphatase levels
- Serum 25-hydroxyvitamin D level
- Parathyroid hormone and thyroid-stimulating hormone tests
- 24-hour urine test for calcium and creatinine
- Additional specific tests may be necessary, such as:
- Total and free testosterone levels in men
- Estradiol, follicle-stimulating hormone, luteinizing hormone, and prolactin levels in young amenorrheic women
- Simultaneous serum phosphate and creatinine, spot urine phosphate, and creatinine to calculate the fractional excretion of phosphate (for patients receiving tenofovir) The goal of this comprehensive approach is to identify and treat the underlying cause of secondary osteoporosis, which can significantly improve bone health outcomes and prevent fractures, often requiring specific treatments beyond standard osteoporosis medications, as suggested by the study 1.
- It is essential to prioritize the identification and treatment of underlying causes, as this can have a significant impact on morbidity, mortality, and quality of life.
- By following this approach, healthcare providers can provide personalized care and improve outcomes for patients with secondary osteoporosis, as recommended by the study published in Clinical Infectious Diseases in 2010 1.
From the Research
Diagnostic Approach
The workup for secondary osteoporosis involves a comprehensive evaluation to identify underlying causes of bone loss. The following diagnostic studies should be considered initially:
- Complete blood count
- Complete metabolic panel
- 25-hydroxyvitamin D level
- Testosterone level in men
- 24-hour urinary calcium, sodium, and creatinine 2 Further testing may be performed in selected patients depending on the clinical picture and results of the initial workup.
Laboratory Testing
Laboratory testing for secondary osteoporosis may include:
- 25-hydroxyvitamin D
- Parathyroid hormone (PTH)
- Serum and urine calcium
- Phosphate
- Creatinine
- Liver function tests
- A complete blood count
- Testosterone in men
- Thyroid-stimulating hormone 3
Evaluation Process
The evaluation process for secondary osteoporosis should include:
- A thorough history
- Physical examination
- Bone mineral density testing
- Laboratory testing 3 A focused medical history, skeletal-related physical examination, assessment of falls risk, and appropriate laboratory tests are essential for evaluating patients with osteoporosis 4
Importance of Evaluation
Evaluating patients for secondary causes of osteoporosis is crucial to:
- Identify potentially correctable conditions contributing to skeletal fragility and fracture risk
- Assist in individualizing management decisions
- Optimize clinical outcomes 4 Failure to identify and address underlying causes of secondary osteoporosis may result in further bone loss despite pharmacologic intervention for osteoporosis 2