Laboratory evaluation for premenopausal osteoporosis

Initial laboratory tests

Complete chemistry profile (including alkaline phosphatase)

Complete blood count

Calcium, phosphorus

25-hydroxyvitamin D

TSH

24-hour urine for calcium and creatinine

Additional laboratory tests if indicated

Estradiol, LH, FSH, prolactin

PTH

1,25-dihydroxyvitamin D

24-hour urine for free cortisol (or dexamethasone suppression test)

Iron/TIBC, ferritin

Celiac screen (serologies)

Serum/urine protein electrophoresis

Erythrocyte sedimentation rate or C-reactive protein

Rheumatoid factor

Vitamin A/retinol level

Specific testing for rare conditions (eg, mastocytosis, hemochromatosis) if clinically indicated

Genetic evaluation may be pursued if primary forms of osteoporosis are suspected

Bone turnover markers

Transiliac crest bone biopsy

TSH: thyroid-stimulating hormone; LH: luteinizing hormone; FSH: follicle-stimulating hormone; PTH: parathyroid hormone; TIBC: total iron-binding capacity.

Courtesy of Carolyn Becker, MD and Adi Cohen, MD.

Graphic 53634 Version 9.0

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Laboratory evaluation for premenopausal osteoporosis