Pharmacologic: Vitamin D overdose, vitamin A overdose, corticosteroids (oral, inhaled, nasal), chemotherapy drugs, long-term heparin or warfarin therapy, aluminum-containing antacids Symptoms Result from fractures of vertebrae, wrist, hip, humerus Generalized skeletal pain is uncommon Pain usually results from collapse of the vertebrae, often with minimal trauma Hip fractures from moderate trauma impaired ability to walk Distal forearm fx: to break a fall Work-Up Tests to R/O secondary osteoporosis: CBC, ESR Liver function tests Thyroid function tests levels of albumin, phosphorous, alkaline phosphate, creatinine, and calcium Alkaline phosphatase will be increased if there is a healing fracture Serum levels of testosterone and luteinizing hormone (LH) should be included because of the clear association of hypogonadism and osteoporosis in men The total testosterone level, which measures bound and free testosterone in the serum, is the preferred test. Testosterone levels normally undergo rapid diurnal changes; they are highest in the morning and drop by 30-50% in mid-afternoon Differential Diagnosis of Osteoporosis [From: Lawson, M.J. (2001). Evaluating and managing osteoporosis in men. In CE Connection: Advanced Pharmacology, 44-55.] Laboratory Osteoporosis Osteomalacia Hyperparathyroidism Tumors (such Test as multiple myeloma) calcium Decreased Increased or high Serum Decreased Decreased phosphate Serum alkaline Increased Increased phosphate Other Creatinine, 25 hydroxy Parathyroid hormone CBC, ESR, thyroid profile, vitamin D urinary and testosterone, serum protein leutinizing electrophoresis hormone Bone mineral density measurements (BMD) Helpful in diagnosis and prevention of osteoporosis
Pharmacologic: Vitamin D overdose, vitamin A overdose, corticosteroids (oral, inhaled, nasal), chemotherapy drugs, long-term heparin or warfarin therapy, aluminum-containing antacids Symptoms Result from fractures of vertebrae, wrist, hip, humerus Generalized skeletal pain is uncommon Pain usually results from collapse of the vertebrae, often with minimal trauma Hip fractures from moderate trauma impaired ability to walk Distal forearm fx: to break a fall Work-Up Tests to R/O secondary osteoporosis: CBC, ESR Liver function tests Thyroid function tests levels of albumin, phosphorous, alkaline phosphate, creatinine, and calcium Alkaline phosphatase will be increased if there is a healing fracture Serum levels of testosterone and luteinizing hormone (LH) should be included because of the clear association of hypogonadism and osteoporosis in men The total testosterone level, which measures bound and free testosterone in the serum, is the preferred test. Testosterone levels normally undergo rapid diurnal changes; they are highest in the morning and drop by 30-50% in mid-afternoon Differential Diagnosis of Osteoporosis [From: Lawson, M.J. (2001). Evaluating and managing osteoporosis in men. In CE Connection: Advanced Pharmacology, 44-55.] Laboratory Test Osteoporosis Osteomalacia Hyperparathyroidism Tumors (such as multiple myeloma) calcium Decreased Increased or high Serum phosphate Decreased Decreased Serum alkaline phosphate Increased Increased Other Creatinine, thyroid profile, testosterone, leutinizing hormone 25 hydroxy vitamin D Parathyroid hormone CBC, ESR, urinary and serum protein electrophoresis Bone mineral density measurements (BMD) Helpful in diagnosis and prevention of osteoporosis
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