Utility of laboratory tests in evaluation of fracture risk and in differential diagnostics of low bone mass in asymptomatic postmenopausal women

Abstract

Introduction: Until now, there are no specific guidelines for laboratory evaluation in asymptomatic patients with low bone mineral density (BMD). The aim of the study was to estimate the utility of laboratory tests in evaluation of fracture risk and in differential diagnostics of low bone mass in asymptomatic postmenopausal women.
Material and methods: That was a retrospective study of 207 women. The results of laboratory investigations, densitometry and thoraciclumbar X-rays were analyzed. The relationship between BMD, vertebral fractures and abnormal lab tests was investigated. In patients with low BMD, reasons of this pathology was determined and costs of differential diagnostics were estimated.
Results: There were no differences in prevalence of abnormal lab tests in women with BMD that met and didn’t meet densitometry criteria of osteoporosis (85.05% vs. 82.00%). Similarly, in people with and without vertebral fractures (84.44% vs. 86.27%). There was no relationship between osteoporosis and abnormal tests except of high PTH in the group with vertebral fractures. In 64% of women, the cause of low BMD was asymptomatic pathology other then primary osteoporosis - most often vitamin D deficiency (52.0%). Costs of lab tests used in differential diagnostics were between 45 and 153 PLN, person and 182.50-409.10 PLN per diagnosis.
Conclusions:
1. Laboratory tests aren’t useful to assess fracture risk.
2. In 64% of asymptomatic postmenopausal women with low BMD, the cause of this abnormality may by pathology that coexists with primary osteoporosis.
3. To assess the cause of low BMD, except basic lab tests, 25(OH)D should be tested.