Appropriate Tests


Clinical assessment, including age, gender, presence of systemic disease.

See also Bone fracture (pathological).


Investigation may be appropriate to demonstrate increased bone loss prior to the development of clinical disease in high risk patients; to establish the diagnosis of osteoporosis; to monitor efficacy of treatment. Osteoporosis is diagnosed based on bone density (BMD) measurement and is defined as a BMD T score of £-2.5. Absolute fracture risk calculation is used to inform treatment decision http://garvan.org.au/promotions/bone-fracture-risk/calculator/


Other investigation may include diagnostic imaging to demonstrate fractures. Laboratory investigations may include Calcium, Phosphate, Albumin, Vitamin D, Alkaline phosphatase; fasting spot urine Calcium and, Creatinine , and bone turnover markers (BTM).

The recommended BTM are serum procollagen type I N propeptide (PINP) for bone formation and serum C-terminal cross-linking telopeptide of type I collagen (CTX) for bone resorption, which may be especially useful in monitoring treatment for which baseline and serial measurements are required. Urine deoxypyridinoline (DPD) or urine N-terminal cross-linking telopeptide of type I collagen (NTX) may be used as alternative bone resorption markers.


Bone loss commences prior to the menopause.

Cushing's syndrome




Plasma cell myeloma


Gonadal hypofunction 

See Amenorrhoea, Testicular failure.





Chronic metabolic acidosis, especially

  • Chronic renal failure
  • Renal tubular acidosis
  • Organic acidaemias

Bone may also show osteomalacia/rickets and effects of hyperparathyroidism. Bone specific alkaline phosphatase (B-ALP) or intact PINP assays are least affected by renal impairment.

Juvenile osteoporosis




Disuse atrophy


Sudeck's atrophy


Paget's disease of the bone



Vasikaran S, et al. Osteoporos Int 2011;22(2):391-420

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