Work-Up of Secondary Causes

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What is the work-up for secondary causes of osteoporosis?

All patients diagnosed with osteoporosis should be considered candidates for evaluation for secondary (treatable) causes, with some or all of these tests:

  • Serum calcium and albumin to evaluate for hyperparathyroidism

  • TSH to evaluate for hyperthyroidism

  • Basic metabolic profile (BMP) to evaluate for renal failure and acidosis

  • Alkaline phosphatase to evaluate for other bony abnormality (Paget's, multiple myeloma)

  • Possibly 25-OH vitamin D level to evaluate for deficiency

  • Testosterone level in men with treatable symptoms (testosterone, like estrogen is not recommended as therapy for osteoporosis, except when the benefit outweighs the risk)

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