Osteoporosis

Causes	Appropriate Tests
	Clinical assessment, including age, gender, presence of systemic disease. See also Bone fracture - pathological.
Generalised	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. Investigation may include bone density measurement and diagnostic imaging; calcium, phosphate, albumin, vitamin D, ALP; urine - calcium, creatinine, collagen crosslink fragments or hydroxyproline with hydroxyproline/creatinine ratio. Collagen crosslink fragments are more specific for bone resorption than hydroxyproline.
Post-menopausal	Bone loss commences prior to the menopause.
Cushing's syndrome	See Cushing's syndrome.
Hyperthyroidism	See Hyperthyroidism.
Multiple myeloma	See Multiple myeloma.
Gonadal hypofunction	See Amenorrhoea, Testicular failure.
Alcoholism	See Alcoholism.
Malabsorption	See Malabsorption.
Chronic metabolic acidosis, especially Chronic renal failure Renal tubular acidosis Organic acidaemias	Bone may also show osteomalacia/rickets and effects of hyperparathyroidism.
Juvenile osteoporosis
Localised
Disuse atrophy
Sudeck's atrophy
Paget's disease of bone	See Paget's disease of the bone.

Glossary Terms