Which laboratory tests are routinely evaluated when assessing osteoporosis?

• A. Serum calcium, phosphate, alkaline phosphatase, 25-hydroxy vitamin D, PTH, thyroid function; renal function as needed
• B. Only glucose and lipid panel
• C. Only CBC
• D. Only bone turnover markers

Answer: (D)

When evaluating osteoporosis, it's important to look at factors that influence bone metabolism and mineral balance, not just bone density. A routine lab workup typically includes calcium and phosphorus to check mineral homeostasis, alkaline phosphatase as a general signal of bone turnover, and 25-hydroxy vitamin D to assess vitamin D status. Parathyroid hormone levels help evaluate parathyroid control of calcium balance, and thyroid function tests are important because thyroid disorders can accelerate or slow bone remodeling. Renal function is checked as needed since kidney health affects vitamin D activation and mineral excretion. Bone turnover markers measure the rate of bone remodeling, but they are not part of routine baseline evaluation because of variability and lack of standardization; they’re more useful for monitoring therapy in specific contexts rather than diagnosing osteoporosis. So the standard initial approach relies on a broad panel of mineral and endocrine tests, with bone turnover markers reserved for selective use rather than routine assessment.