From the Guidelines
For patients suspected of having osteoporosis, the recommended laboratory tests include a comprehensive metabolic panel to assess calcium, phosphorus, and alkaline phosphatase levels; complete blood count; 25-hydroxyvitamin D level; thyroid function tests; and a dual-energy X-ray absorptiometry (DXA) scan to measure bone mineral density, as suggested by the most recent guidelines 1.
Laboratory Tests
The following laboratory tests are recommended:
- Comprehensive metabolic panel to assess calcium, phosphorus, and alkaline phosphatase levels
- Complete blood count
- 25-hydroxyvitamin D level
- Thyroid function tests
- Dual-energy X-ray absorptiometry (DXA) scan to measure bone mineral density
Treatment Options
Treatment options begin with lifestyle modifications including:
- Weight-bearing exercise
- Adequate calcium intake (1000-1200 mg daily)
- Vitamin D supplementation (800-1000 IU daily) First-line pharmacological treatment typically involves bisphosphonates such as:
- Alendronate (70 mg orally once weekly)
- Risedronate (35 mg orally once weekly)
- Zoledronic acid (5 mg IV once yearly) For patients who cannot tolerate bisphosphonates or have severe osteoporosis, alternatives include:
- Denosumab (60 mg subcutaneously every 6 months)
- Teriparatide or abaloparatide (both anabolic agents given as daily subcutaneous injections for up to 2 years)
- Raloxifene (60 mg orally daily)
Treatment Duration
Treatment duration varies but typically involves 3-5 years of bisphosphonate therapy followed by reassessment, as recommended by recent studies 1.
Mechanism of Action
These medications work by either inhibiting bone resorption (bisphosphonates, denosumab, raloxifene) or stimulating new bone formation (teriparatide, abaloparatide), effectively increasing bone density and reducing fracture risk, as supported by the evidence 1.
From the FDA Drug Label
In osteoporosis treatment studies alendronate sodium 10 mg/day decreased the markers of bone formation, osteocalcin and bone specific alkaline phosphatase by approximately 50%, and total serum alkaline phosphatase by approximately 25 to 30% to reach a plateau after 6 to 12 months The decrease in the rate of bone resorption indicated by these markers was evident as early as one month and at three to six months reached a plateau that was maintained for the entire duration of treatment with alendronate sodium Throughout the Phase 3 studies, transient decreases from baseline in serum calcium (less than 1%) and serum phosphate (less than 3%) and compensatory increases in serum PTH levels (less than 30%) were observed within 6 months in patients in osteoporosis clinical trials treated with risedronate sodium immediate-release 5 mg daily
The recommended laboratory tests for patients suspected of having osteoporosis include:
- Bone markers: such as osteocalcin, bone specific alkaline phosphatase, and total serum alkaline phosphatase to assess bone formation
- Serum calcium and serum phosphate levels to monitor for changes in bone mineral density
- PTH levels to assess parathyroid function The treatment options for patients with osteoporosis include:
- Bisphosphonates: such as alendronate and risedronate, which decrease bone resorption and increase bone mass
- Calcium and vitamin D supplementation: to support bone health and prevent further bone loss 2, 3
From the Research
Laboratory Tests for Osteoporosis
- Serum calcium, alkaline phosphatase, vitamin D, and parathormone are commonly performed tests to exclude secondary causes of osteoporosis and monitor the response to therapy 4
- Biochemical markers of bone turnover, such as serum procollagen type 1 amino-terminal propeptide and β-form of C-terminal cross-linked telopeptide of type I collagen (β-CTx-1/β-CrossLaps), are used to monitor individual patients with osteoporosis 4
- Measurements of 25-hydroxyvitamin D, serum and urine calcium, and some estimation of renal function are recommended for all patients with osteoporosis 5
- Dual-emission x-ray absorptiometry is used to measure bone mineral density and monitor progression of osteoporosis and effects of therapy 6, 7
Treatment Options for Osteoporosis
- Calcium and vitamin D are the basic treatment for osteoporosis 8
- Currently approved treatments for osteoporosis include selective estrogen receptor modulators (SERMs), bisphosphonates, denosumab, teriparatide, calcitonin, and others 8
- First-line therapy most often is a bisphosphonate, while estrogen reduces hip fractures in women 6
- Recombinant parathyroid hormone is reserved for patients who have failed or are not candidates for bisphosphonate therapy 6
- Treatment of underlying conditions, such as secondary osteoporosis, may be sufficient to lessen fracture risk, although some patients may also need usual treatment for osteoporosis 5