Skip to main content

Advertisement

SpringerLink
Log in

Clinical utility of laboratory testing in women with osteoporosis

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Clinicians regularly order laboratory tests in women with osteoporosis to assess if an underlying medical condition is contributing to bone loss. To determine which laboratory tests are associated with osteoporosis we conducted a secondary analyses of data collected as part of the Fracture Intervention Trial (FIT), which included 15,316 postmenopausal women. Women had tests of liver and kidney function, mineral metabolism, electrolytes and complete blood count, femoral neck and total body BMD and spinal radiographs. The prevalence of abnormal tests in women with osteoporosis compared to women without was not different, except for low TSH (<0.5 IU/ml). Among women with and without osteoporosis at the femoral neck the prevalence of low TSH was 4.9% (95% CI: 4.4–5.5) and 3.7% (95% CI: 3.3–4.1), respectively, yielding a positive likelihood ratio of 1.2 (95% CI: 1.1–1.3). We observed similar results for women with vertebral fractures compared to women without vertebral fractures; positive likelihood ratio of 1.4 (95% CI: 1.3–1.6). Our data suggests that when assessing healthy women with osteoporosis ordering a routine panel of laboratory tests is not useful but measuring TSH may be informative.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Harper KD, Weber TJ (1998) Secondary osteoporosis. Diagnostic considerations. Endocrinol Metab Clin N Am 27:325–348

    CAS  Google Scholar 

  2. Wehren LE (2002) The role of the primary care physician in diagnosis and management of osteoporosis. Int J Fertil Womens Med 47:116–122

    PubMed  Google Scholar 

  3. Bjoro K, Brandsaeter B, Wiencke K, Bjoro T, Godang K, Bollerslev J (2003) Secondary osteoporosis in liver transplant recipients: a longitudinal study in patients with and without chronic liver disease. Scand J Gastroenterol 38:320–327

    Article  CAS  PubMed  Google Scholar 

  4. Cakir B, Odabasi E, Turan M, Guler S, Kutlu M (2002) Secondary osteoporosis in women. A retrospective analysis. Arch Gynecol Obstet 266:214–217

    Article  CAS  PubMed  Google Scholar 

  5. Fitzpatrick LA (2002) Secondary causes of osteoporosis. Mayo Clin Proc 77:453–468

    PubMed  Google Scholar 

  6. Gennari C, Martini G, Nuti R (1998) Secondary osteoporosis. Aging 10:214–224

    CAS  PubMed  Google Scholar 

  7. Stein E, Shane E (2003) Secondary osteoporosis. Endocrinol Metab Clin N Am 32:115–134

    Google Scholar 

  8. Riggs BL (2003) Role of the vitamin-D endocrine system in the pathophysiology of postmenopausal osteoporosis. J Cell Biochem 88:209–215

    Article  CAS  PubMed  Google Scholar 

  9. Simon J, Leboff M, Wright J, Glowacki J (2002) Fractures in the elderly and vitamin D. J Nutr Health Aging 6:406–412

    CAS  PubMed  Google Scholar 

  10. Duarte MP, Farias ML, Coelho HS, Mendonca LM, Stabnov LM, do Carmo d’Oliveira M, Lamy RA, Oliveira DS (2001) Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease. J Gastroenterol Hepatol 16:1022–1027

    Article  CAS  PubMed  Google Scholar 

  11. Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501

    Article  CAS  PubMed  Google Scholar 

  12. Hirano Y, Kishimoto H, Haino H, Teshima R (1999) The change of bone mineral density in secondary osteoporosis and vertebral fracture incidence. J Bone Miner Metab 17:119–124

    Google Scholar 

  13. Eastell R, Reid DM, Compston J, Cooper C, Fogelman I, Francis RM, Hay SM, Hosking DJ, Purdie DW, Ralston SH, Reeve J, Russell RG, Stevenson JC (2001) Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action? Q J Med 94:575–597

    Article  CAS  Google Scholar 

  14. Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 12:S1–34

    Google Scholar 

  15. Heinemann DF (2000) Osteoporosis. An overview of the National Osteoporosis Foundation clinical practice guide. Geriatrics 55:31–36

    CAS  Google Scholar 

  16. Kanis JA, Torgerson D, Cooper C (2000) Comparison of the European and USA practice guidelines for osteoporosis. Trends Endocrinol Metab 11:28–32

    Article  CAS  PubMed  Google Scholar 

  17. Guidelines for the early detection of osteoporosis and prediction of fracture risk (1996) Council of the National Osteoporosis Foundation. S Afr Med J 86:1113–1116

    PubMed  Google Scholar 

  18. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541

    Article  CAS  PubMed  Google Scholar 

  19. Black DM, Reiss TF, Nevitt MC, Cauley J, Karpf D, Cummings SR (1993) Design of the Fracture Intervention Trial. Osteoporos Int 3:S29–39

    Google Scholar 

  20. WHO (1994) Assessment of osteoporotic fracture risk and its role in screening for postmenopausal osteoporosis. WHO Technical Series, Geneva

  21. Genant HK, Jergas M (2003) Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int 14:S43–55

    Article  PubMed  Google Scholar 

  22. Genant HK, Engelke K, Fuerst T, Gluer CC, Grampp S, Harris ST, Jergas M, Lang T, Lu Y, Majumdar S, Mathur A, Takada M (1996) Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 11:707–730

    CAS  PubMed  Google Scholar 

  23. Simel DL, Samsa GP, Matchar DB (1991) Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol 44:763–770

    Article  CAS  PubMed  Google Scholar 

  24. Bauer DC, Ettinger B, Nevitt MC, Stone KL (2001) Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Ann Int Med 134:561–568

    CAS  PubMed  Google Scholar 

  25. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773

    Article  CAS  PubMed  Google Scholar 

  26. Tannenbaum C, Clark J, Schwartzman K, Wallenstein S, Lapinski R, Meier D, Luckey M (2002) Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J Clin Endocrinol Metab 87:4431–4437

    Article  CAS  PubMed  Google Scholar 

  27. Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S (2003) Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors. Osteoporos Int 14:577–582

    Article  CAS  PubMed  Google Scholar 

  28. Rucker D, Allan JA, Fick GH, Hanley DA (2002) Vitamin D insufficiency in a population of healthy western Canadians. CMAJ 166:1517–1524

    PubMed  Google Scholar 

  29. Sahota O, Gaynor K, Harwood RH, Hosking DJ (2001) Hypovitaminosis D and “functional hypoparathyroidism”—the NoNoF (Nottingham Neck of Femur) study. Age Ageing 30:467–472

    Article  CAS  PubMed  Google Scholar 

  30. Kessenich CR, Rosen CJ (1996) Vitamin D and bone status in elderly women. Orthop Nurs 15:67–71

    CAS  PubMed  Google Scholar 

  31. Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD (1982) Vitamin D and bone health in the elderly. Am J Clin Nutr 36:1014–1031

    CAS  PubMed  Google Scholar 

  32. Jesudason D, Need AG, Horowitz M, O’Loughlin PD, Morris HA, Nordi BE (2002) Relationship between serum 25-hydroxyvitamin D and bone resorption markers in vitamin D insufficiency. Bone 31:626–630

    Article  CAS  PubMed  Google Scholar 

  33. Kudlacek S, Schneider B, Peterlik M, Leb G, Klaushofer K, Weber K, Woloszczuk W, Willvonseder R for the Austrian Study Group on Normative Values of Bone Metabolism (2003) Assessment of vitamin D and calcium status in healthy adult Austrians. Eur J Clin Invest 33:323–331

    CAS  PubMed  Google Scholar 

  34. Calvo MS, Whiting SJ (2003) Prevalence of vitamin D insufficiency in Canada and the United States: importance to health status and efficacy of current food fortification and dietary supplement use. Nutr Rev 61:107–113

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

Dr. Jamal is supported by a Canadian Institute of Health Research (CIHR) Phase 1 Clinician Scientist Award.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology and Metabolism, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

    Sophie A. Jamal & Richard E. Leiter

  2. Department of Medicine, Division of General Internal Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

    Ahmed M. Bayoumi

  3. Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco, Calif., USA

    Douglas C. Bauer

  4. San Francisco Coordinating Center and Research Institute at the California Pacific Medical Center, San Francisco, Calif., USA

    Steven R. Cummings

  5. St. Michael’s Hospital, 61 Queen Street East, Room 6113, Toronto, Ontario, M5C 2T2, Canada

    Sophie A. Jamal

Authors
  1. Sophie A. Jamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard E. Leiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed M. Bayoumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Douglas C. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven R. Cummings
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sophie A. Jamal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jamal, S.A., Leiter, R.E., Bayoumi, A.M. et al. Clinical utility of laboratory testing in women with osteoporosis. Osteoporos Int 16, 534–540 (2005). https://doi.org/10.1007/s00198-004-1718-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1718-y

Keywords

Search

Navigation