Osteoporosis
Testing
By Margie Bissinger
DEXA measures only bone density and not bone quality. Bone
DUAL X-RAY quality is just as important as bone density when it comes to
ABSORPTIOMETRY resisting fractures. More than half of postmenopausal women who
(DEXA) have a bone fracture don’t have osteoporosis according to WHO
criteria. We need to look at other tests in addition to DEXA.
VERTEBRAL
Some DEXA tests can show you a VFA. This is a low resolution x-ray
FRACTURE
of the spine looking for hidden spinal fractures.
ASSESSMENT (VFA)
FRACTURE RISK The FRAX score is calculated based on 12 personal, lifestyle, and
medical factors to determine your 10 year probability of having an
ASSESSMENT TOOL
osteoporosis fracture in the next 10 years. It includes looking at the
(FRAX)
BMD T-score of the femoral neck.
Gives you additional clinical information on bone quality. It is software that
TRABECULAR BONE is added to certain DEXA machines. I highly recommend this test if it is
SCORE (TBS) possible to get because bone strength is a combination of bone density and
bone quality. Click to find a facility near you.
INTERPRETING BONE MINDERAL DENSITY
TESTING VIA DEXA T-SCORE RESULTS
Provided by the World Health Organization (WHO)
Normal -1 and above
Osteopenia Between -1 and -2.5
Osteoporosis -2.5 or lower
-2.5 or lower and presence of at
Severe Osteoporosis
least one fragility fracture
ASSISTANCE
Dr. Lani Simpson will give a second opinion or Dr. Keith McCormick for consults.
COMPLETE
This is a blood test. It's used to look at overall health and find a wide
BLOOD COUNT range of conditions, including anemia.
(CBC)
This test should be done fasting. It measures 14 different substances in your
blood. It provides important information about your body's chemical balance
and how the body uses food and energy. In this panel it is essential to look at
the total serum calcium. The range considered normal is often too large and
COMPREHENSIVE parathyroid tumors are missed. According to parathyroid surgeon, Dr. Deva
Boone. If you are over 40 your number should be in the mid-high 9’s (mg/dL). If
METABOLIC your level is over 10 mg/dL, you should be evaluated for parathyroid disease.
PANEL (CMP) Low values should also be looked at. The second test that needs to be looked at
carefully is your fasting glucose level. Elevated blood glucose can increase
inflammation and stimulate osteoclasts to break down bone in addition to other
negative effects. It is also a good idea to get a hemoglobin A1C which is a
measure of your average blood sugar over the past three months.
(C-terminal cross-linking telopeptides of type 1 collagen) CTX is a bone-
CTX resorption marker that measures how much bone collagen is in your
blood. The higher the level, the more bone breakdown is occurring by
the osteoclasts.
(High-sensitivity C-reactive protein) is a marker of inflammation. If it is
CRP elevated it indicates too much interleukin 6 that stimulates osteoclast
activity and is linked to a higher risk of osteoporosis.
(Serum) - this test rules out blood protein disorders such as multiple
ELECTROPHORESIS myeloma. It helps with unexplained symptoms such as peripheral
neuropathy, anemia, bone pain, back pain, kidney disease, and bone loss.
There are certain gene mutations that can be associated with bone loss
and osteoporosis. There are numerous genetic tests available. It is
important to make sure that your data is kept private and confidential.
MTHFR gene mutation - can cause increase homocysteine and
GENETIC increased osteoclast activity
Interleukin 6 gene mutation - affects inflammation and can result in
TESTING increased bone breakdown
Vitamin D Receptor (VDR) gene mutation can be a factor for people
who are unable to increase their vitamin D levels even though they
are taking high doses of vitamin D.
AGXT gene mutation prevents people from breaking down oxalates.
The most comprehensive test that I have found is the Wheat
GLUTEN Zoomer by Vibrant America. It tests sensitivity to wheat/gluten
TESTING as well as intestinal permeability. There are also other gluten
antibody tests available.
It is important to work with a practitioner on the appropriate tests
HORMONE for you. These tests include sensitive estradiol, DHEA-5, and Dutch
tests (complete and plus). The Dutch plus gives more information on
TESTING cortisol awakening response
An amino acid that when elevated has a negative effect on collagen
fibers, making bone stiff, fragile, and more prone to fracture. It can
also be used as a marker of B vitamin status. Levels higher than 8
µmol/L can contribute to inflammation. Levels higher than 15 µmol/L
HOMOCYSTEINE have been correlated with a reduction in bone density and an
increase in fracture risk. Often times your test result will be “normal”
on the lab report, but it isn’t optimal and there are things that can be
done to improve this such as supplementation with folate and B
vitamins.
IONIZED Measure of freely floating calcium in the blood not bound to protein.
CALCIUM
Magnesium deficiency is common and negatively affects your bones.
MAGNESIUM The Red Blood Cell Magnesium test is the most accurate.
(Procollagen type 1 N-terminal propeptide) -This is a bone-formation
P1NP marker that the bone building activity of the osteoblasts.
PARATHYROID (PTH intact) - This test evaluates the function of the parathyroid
HORMONE glands. The results need to be looked at in conjunction with your
blood calcium values.
It is important this nutrient be balanced with calcium. High
PHOSPHORUS
phosphorus levels are detrimental to bone health.
(TSH) - This is the basic thyroid screening test. There are different
THYROID- values for normal versus optimal levels. A more detailed thyroid
STIMULATING workup should be considered if thyroid disease is suspected.
HORMONE Hyperthyroidism is a root cause of osteoporosis.
(25-hydroxyvitamin D) - The 25(OH)D test is the inactive form of
VITAMIN D vitamin D and it is the most accurate way to measure how much
25(OH)D vitamin D is in your blood. If you have normal parathyroid
function according to Dr. Deva Boone this is the only vitamin D
test that is needed.
VITAMIN D This is the active form of Vitamin D which is important to check
1,25(OH)2 D in anyone who may have a parathyroid tumor.
This is an important test. Your body works hard to maintain the
24-HOUR right amount of calcium in your blood. If your blood calcium is
too high, more calcium will be excreted in the urine. If your
URINE
blood calcium is too low, your body will take calcium from your
CALCIUM bones. If your 24-hour urine calcium is too low it may indicate
low calcium intake or malabsorption.
