Exclude secondary causes of osteoporosis

• full blood count, ESR or C-reactive protein - for inflammatory causes of spinal deformities, marrow infiltration
• serum and urine electrophoresis - in patients with vertebral fractures to exclude myeloma
• biochemical profile, bone profile is usually normal unless the alkaline phosphatase is elevated due to recent fracture
• TSH - to exclude hyperthyroidism
• serum 25-hydroxy vitamin D and parathormone – in patients in certain at risk groups ie: asians, housebound, malabsorption, anticonvulsants, pelvic fracture or eating disorder
• serum paraproteins and urine Bence Jones proteins
• anti-endomysial antibody if coeliac disease suspected
• Testosterone, Sex-hormone binding globulin, FSH, LH - to exclude treatable male hypogonadism
• in pre-menopausal women especially if eating disorder or irregular menses: oestrogen, FSH, LH, prolactin
• lateral thoracic and lumbar spine X-ray
• isotope bone scan
• bone biopsy

Reference:

• (1) The Royal Australian College of General Practitioners 2010. Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men