One of many fundamental rules of the Higher Bones Program® is that every one osteoporosis, all extreme bone loss, or all actual elevated threat of low-trauma fracture has a trigger. To raised perceive any undetected causes of bone loss, it is very important receive a medical work-up — that’s, additional exams that may assist discover the causes of osteoporosis.
Along with the usual DEXA bone density take a look at, we propose that our purchasers focus on the next exams with their physician to see which of them are acceptable. Under are examples of exams that might be useful and the fundamentals of what the take a look at outcomes imply as a way to higher focus on your private state of affairs together with your physician. (Get a printable model of those exams right here to deliver to your physician) . . . then be part of us for the webinar that explains these medical exams for osteoporosis!
- Vitamin D 25(OH)D blood take a look at (Out there At-Dwelling)
- Ionized calcium take a look at *
- Intact parathyroid hormone blood take a look at (iPTH)*
- 24-hour urine calcium excretion take a look at *
- Thyroid hormone perform take a look at (TSH)*
- N-telopeptides crosslinks (NTx) urine marker of bone resorption take a look at*
- N-telopeptides crosslinks (NTx) serum marker of bone resorption take a look at*
- Dpd urine marker of bone resorption take a look at (deoxypyridinium crosslinks take a look at)
- Vertebral deformity evaluation
- Free cortisol take a look at (blood or saliva)*
- DHEA take a look at (blood or saliva)*
- C-reactive protein take a look at (excessive sensitivity if doable)*
- Homocysteine take a look at (plasma or serum)*
- Celiac illness and gluten sensitivity take a look at*
- Intercourse hormone take a look at*
- Omega 3 Index (Out there At-Dwelling)
*A few of these exams can be found from a self-pay service that has partnered with the Higher Bones Basis. In case you are unable to entry these exams out of your physician, scroll to the tip of this weblog for extra data.
Exams to assist reveal what causes osteoporosis
Vitamin D 25(OH)D blood take a look at
This take a look at determines your blood stage of vitamin D. The outcomes inform you the quantity of vitamin D supplementation wanted to succeed in a therapeutic blood stage of vitamin D, which is vital for sufficient calcium absorption and fundamental bone help.
What your outcomes inform you: The reported “regular” vary could be very large, usually from 30 to 100 ng/mL. We now know that something lower than 32 ng/mL is more likely to significantly restrict calcium absorption and result in bone loss. On the Heart for Higher Bones, we attempt for a 50-70 ng/mL blood stage of 25(OH)D.
Ionized calcium take a look at
This can be a easy blood take a look at to measure the extent of free calcium — that’s, the metabolically energetic portion of calcium not sure to proteins within the blood. This take a look at isn’t meant to evaluate the appropriateness of your calcium consumption as a lot as it’s meant as an oblique take a look at of parathyroid functioning (see under). It may possibly additionally not directly inform us some issues about vitamin D standing.
What your outcomes inform you: The physique controls free calcium within the blood very tightly, with a traditional laboratory vary between 4.8 and 5.2 mg/dL (between 1.2 and 1.3 mmol/L) as reported by the Merck Index. When pondering of bone well being, we search for excessive ionized calcium as a doable oblique indicator of extreme parathyroid hormone exercise. A low ionized calcium stage is likely to be associated to low albumin and low protein standing.
Intact parathyroid hormone blood take a look at (iPTH)
Excessive parathyroid hormone ranges are related to extreme bone loss, as an overactive parathyroid gland attracts calcium from bone. The medical causes for this overactivity have to be addressed to halt the extreme bone loss. Additionally, a traditional parathyroid studying within the face of vitamin D deficiency can point out magnesium inadequacy.
What your outcomes inform you: On the Heart for Higher Bones, we search for an intact parathyroid hormone stage inside the regular vary established by the actual testing laboratory. Two widespread causes of an excessively excessive parathyroid hormone stage are vitamin D deficiency (which is definitely corrected with correct vitamin D3 supplementation and monitoring); and an overactive parathyroid, which is most frequently resulting from benign tumors on the parathyroid glands. Correction of this case usually requires surgical procedure to take away the overactive glands.
Excessively excessive parathyroid hormone ranges trigger the physique to launch an excessive amount of calcium from the bone contributing to bone loss, and extra importantly, excessive blood calcium. A excessive parathyroid situation is finest handled by an endocrinologist.
24-hour urine calcium excretion take a look at
This take a look at seems to be at how a lot calcium is being excreted within the urine. For this take a look at, you acquire all of your urine over 24 hours in a big container for laboratory evaluation to measure the quantity of calcium within the complete quantity of urine. Extreme urinary calcium excretion is a standard reason behind bone loss and osteoporosis.
What your outcomes inform you: The traditional laboratory vary for an individual consuming a mean food plan is round 100 to 250 mg of calcium misplaced within the urine every day. I think about a calcium lack of greater than 250 mg to be a priority. In such instances, step one is to cease all calcium dietary supplements for 4 to five days after which retest the 24-hour urine calcium. If the urine calcium loss remains to be excessive, then steps ought to be taken to scale back this lack of calcium within the urine, as it could actually trigger bone loss. Dietary, life-style, and medical approaches may also help.
Thyroid hormone perform take a look at (TSH)
TSH is a hormone produced within the pituitary gland that alerts the thyroid to provide extra of its hormones. If TSH is excessive, it often signifies that the thyroid isn’t producing sufficient T3 and T4, so checking your TSH stage is a straightforward manner of screening for an underactive thyroid. Thyroid hormone ranges which can be too excessive or too low can contribute to osteoporosis, as can a dose of thyroid treatment that’s too excessive. To display for overactive thyroid, or to verify your dose of thyroid medicines isn’t too excessive for those who’re already being handled for hypothyroidism, you’ll want exams without spending a dime T3 and free T4.
What your outcomes inform you: The widespread laboratory vary for all adults is 0.35 to five.50 and a extra splendid stage is 0.35 to 2.0.
Markers of bone resorption exams
Bone resorption (or breakdown) exams measure the quantity of 1 particular bone protein within the urine or blood. As one loses bone this bone protein fragment exhibits up within the urine and blood in elevated quantities. On the Heart for Higher Bones, we typically use the N-telopeptides crosslinks (NTx) urine take a look at, however there are a number of others obtainable. One generally used take a look at is the urine Dpd take a look at (deoxypyridinium crosslinks take a look at). There may be additionally an NTx serum take a look at and the CTX serum take a look at.
As there might be a substantial amount of day-to-day variation in urine bone breakdown markers, we’ve developed a two-day assortment process for bone resorption testing for higher accuracy. These directions can be utilized for both the urine NTx or the Dpd take a look at.
N-telopeptides crosslinks (NTx) urine marker of bone resorption take a look at
What your outcomes inform you: The take a look at outcome “regular” vary usually listed on the take a look at report could be very broad. For instance, take a look at experiences from our native lab checklist the premenopausal regular vary for ladies as 17-94 nM BCE/mM creatinine and the postmenopausal vary as 26-124 nM BCE/mM creatinine. The male vary is 3-51. These ranges are far too large to be helpful.
Ideally, a lady wish to have an NTx stage close to that of the common premenopausal girl, which within the urine is round 35, however ranges usually soar into the 60s to 80s or greater in and round menopause. For grownup males, the imply NTx is 27, which is a extra splendid worth than the upper numbers. Additionally, these markers can get very excessive in uncommon ailments akin to Paget’s Illness and bone most cancers. These conditions are uncommon and understood by a educated doctor aware of bone resorption testing.
We use the NTx urine take a look at from Osteomark to evaluate the success of our bone constructing program. We glance to deliver the urine NTx stage right down to the 40’s, which most often signifies that bone breakdown has normalized. There are some instances, nonetheless, the place bone breakdown could be very low, however bone build-up is even decrease. This situation, often called “low turnover osteoporosis,” is detected when an individual has a low NTx, however remains to be shedding vital bone (5-6%) as seen on bone density testing.
N-telopeptides crosslinks (NTx) serum marker of bone resorption take a look at outcomes
What your outcomes inform you: The NTx bone-breakdown marker will also be measured within the blood. The feminine vary listed by the producer is 6.2-19.0 nM BCE/L, with a imply of 12.6. The male vary is usually listed as 5.4-24.2 nM BCE/L, with a imply of 14.8. Once more, this vary is simply too large to be helpful for us on the Heart for Higher Bones. We search for a results of 12 or considerably decrease in girls, and 14 or considerably decrease in males.
Dpd urine marker of bone resorption take a look at (deoxypyridinium crosslinks take a look at)
What your outcomes inform you: This bone resorption take a look at additionally lists a broad vary of regular values — for ladies, 3.0 to 7.4 nM/mM and for males 2.3 to five.4 nM/mM. Clinically, grownup girls ought to try for a Dpd take a look at rating within the 4s, and in males a really perfect stage would possible be considerably decrease.
Vertebral deformity evaluation
That is one other x-ray take a look at for bone that photos every vertebral physique of the backbone and appears to see if there are deformities or fractures. The Vertebral Deformity Evaluation might be performed on newer bone density testing machines, with particular software program that takes a “lateral” view of the backbone.
What your outcomes inform you: The radiologist will give a full report of what she or he sees for every vertebral physique, reporting any abnormalities, deformities, or fractures.
Free cortisol take a look at (blood or saliva)
Cortisol is a corticosteroid hormone produced by the adrenal cortex, which is a part of the adrenal glands. It’s often known as the “stress hormone” as it’s concerned in response to anxiousness and stress. Abnormally excessive cortisol ranges are damaging to bone and as such signify a significant threat issue for osteoporosis and low-trauma fractures. This take a look at might be performed with blood or saliva.
What your outcomes inform you: Cortisol is the “rise up and go” hormone that ought to rise within the early morning and decline in the course of the day. Thus, take a look at outcomes range by what time of day the take a look at was taken. Testing labs will give their regular vary readings and the timing of the take a look at ought to be taken under consideration when deciphering take a look at outcomes.
DHEA take a look at (blood or saliva)
Dehydroepiandrosterone (DHEA) is a hormone produced by each the adrenal glands and the ovaries. DHEA helps to neutralize the consequences of cortisol. DHEA helps to guard and enhance bone density. Stress discount actions like yoga and meditation may also help preserve youthful DHEA stage as we age. Low ranges of DHEA are a threat issue for osteoporosis. This take a look at additionally might be performed with blood or saliva.
What your outcomes inform you: In saliva testing, the outcomes are sometimes correlated with the outcomes of the cortisol testing. It’s also usually measured as DHEA-S, that’s, DHEA in its sulfated type. Once more, every lab will supply its regular vary relying on the take a look at used.
C-reactive protein take a look at (excessive sensitivity if doable)
C-reactive protein is a plasma protein that’s held to be a marker of basic irritation inside the physique. It’s a recognized threat issue for coronary heart illness as a result of coronary heart illness is basically an inflammatory dysfunction. Osteoporosis can be inflammatory in nature and this take a look at is useful in detecting undesirable irritation, which can contribute to bone well being issues.
What your outcomes inform you: Usually, within the C-reactive protein (or CRP) take a look at, the decrease the rating the much less irritation and thus the higher studying. I search for a excessive sensitivity CRP stage lower than 1.0mg/dL.
Homocysteine take a look at (plasma or serum)
Homocysteine is a non-dietary amino acid, a product of the metabolism of a dietary amino acid, methionine. Within the absence of sufficient B nutritional vitamins, homocysteine can accumulate within the physique. Excessive ranges of this substance harm collagen and signify highly effective threat elements for each heart problems and for osteoporotic fractures.
What your outcomes inform you: Regular ranges of homocysteine within the blood vary from 5 to fifteen mM/L. On the Heart for Higher Bones we prefer to see a homocysteine stage of 8 or under.
Celiac illness and gluten sensitivity take a look at
Celiac illness, and even simply sensitivity to gluten, can result in irritation of the intestine. This irritation is expounded to a posh inflammatory cascade which may enhance bone loss. Additionally, these with celiac illness endure from weak digestion and malabsorption of many vitamins together with nutritional vitamins A, Ok, and D. These deficiencies in flip harm bone. If there may be any suggestion of gluten sensitivity or celiac illness, acceptable testing ought to be thought-about
What your outcomes inform you: There are assorted exams used to assist decide if one is affected by gluten intolerance or the autoimmune situation often called celiac illness. Speak together with your healthcare practitioner about what is likely to be best for you.
Intercourse hormone take a look at outcomes
Submit-Menopausal Females: Progesterone, Estrogen
Feminine intercourse hormones drop naturally at menopause amongst all girls, so I don’t typically counsel testing of those hormones. These occupied with this sort of hormone testing, or these taking hormone alternative medicines, ought to be examined for hormone ranges by their doctor.
Pre-Menopausal Females (reproductive years hormone testing): Progesterone, Estrogen
For ladies from their teenagers to menopause, correct ranges of intercourse hormones are essential to bone well being. Low ranges of both estrogen or progesterone can restrict improvement of optimum peak bone mass. Irregular, or continuously missed, intervals ought to be studied by a educated doctor.
In keeping with famous progesterone researcher, endocrinologist Dr. Jerilynn Prior, some 25% of younger girls within the US and Canada fail to develop optimum peak bone mass resulting from undetected ovulatory disturbances which end in low progesterone ranges. Testing of estrogen and progesterone might be useful in pre-menopausal girls with a bone well being concern.
Each blood and saliva testing can be found for pre-menopause intercourse hormone testing. Every testing laboratory could have its vary of regular intercourse hormone take a look at outcomes.
Intercourse Hormone Testing in Males: Testosterone and, at instances, Estrogen
A standard reason behind osteoporosis in males is low testosterone; thus a medical work-up for osteoporosis in males virtually all the time features a take a look at for testosterone. Apparently sufficient, estrogen additionally performs a task in male bone well being and at instances the physicians will take a look at for estrogen in males with osteoporosis.
Each blood and saliva testing can be found for intercourse hormone exams in males. Every testing laboratory could have its vary of regular intercourse hormone take a look at outcomes.
Omega-3 Index+ At-home take a look at
This can be a easy at-home blood take a look at that measures the Omega-3 Index, Omega-6 to
Omega-3 Ratios, Trans Fats Index and Full Profile of 24 particular person fatty acids. This
take a look at will clarify what different fatty acid ranges can (or can’t) inform you about your well being,
based mostly on present analysis. Omega-3 fatty acids have been proven to learn a large
number of well being circumstances. They’ve additionally been related to wholesome growing old generally.
Sadly, most individuals don’t get sufficient of this vital nutrient from their food plan.
As soon as you recognize your blood ranges, you possibly can modify your food plan and alter your blood
ranges in as little as 3-4 months
What your outcomes inform you:
As part of an total wholesome life-style, an Omega-3 Index
within the 8-12% vary could assist to keep up coronary heart, mind, eye and joint well being, and a Trans
Fats Index of lower than 1% could assist to help coronary heart and mind well being. Additional, research
present that an Omega-3 Index rating of 6.8 or above is related to a 35% decrease threat of
deadly coronary heart assaults, a 34% decrease threat of dying from any trigger, and a 4.7 12 months enhance in
further life expectancy when put next with the common American Omega-3 Index
rating of 4.
Everybody deserves the total story on their well being
It looks like at the moment’s well being care has develop into a knee-jerk response of “see a symptom, take a capsule.” However we on the Heart for Higher Bones consider that everybody deserves higher than that. Your bone loss is a symptom of one thing that’s simply not proper in your physique — and moderately than treating the symptom with medicines (and residing with the unintended effects concerned, a few of that are plain horrifying!), I encourage everybody to dig deeper and discover out the supply of the issue.
New Providing from the Higher Bones Basis
Skip the physician and order your exams on-line! So many instances we hear from our purchasers and readers that their MDs aren’t prepared to order the exams that they request. That is such a frequent incidence that we needed to discover a manner for ladies to acquire these mandatory exams. In partnership with The Higher Bones Basis and Evexia Labs, we are actually in a position to supply low-cost self-pay exams for many who need to know WHY they’re shedding bone.
The method is simple . . .
#1 Choose the exams that you’re occupied with and submit your type under. Be sure you embrace your full tackle with metropolis, state, and zip code. We are going to move this data on to the lab in your behalf.
#2 Watch for an electronic mail from Evexia Lab together with your username and password (additionally verify your spam folder). When you log in you’ll then be capable to see the price of the exams and might select to self pay (no insurance coverage accepted). After you pay Evexia will electronic mail you a requisition type for the lab.
#3 Print your requisition and take it to the closest Labcorp facility. Yow will discover a Labcorp near you utilizing this hyperlink: https://www.labcorp.com/labs-and-appointments. Self-pay testing shouldn’t be obtainable in NY, NJ, and RI.
#4. In 2 to 4 weeks after getting the exams performed, you’ll obtain your lab outcomes by way of an electronic mail notifying you that the outcomes are prepared. They are often seen in your account or you possibly can print them out and take them to your physician for interpretation.