Patient Information

Osteoporosis Evaluation

Why are tests done for osteoporosis?

If you have osteoporosis, low bone density, or unexplained bone fractures, tests can determine whether
there are any undetected contributing problems, help in the selection of medication for treatment, find out
whether you are responding to treatment as expected, or evaluate poor response to treatment.

What tests are usually done?

A 24-hour urine collection can show if there is a problem with intestinal absorption of calcium or leakage
of calcium through the kidneys. Blood tests are done to check things such as blood chemistries (to see if
your calcium or phosphorous level is too high or too low, or if there is a problem with liver or kidney function),
blood count (checking for anemia), proteins (to be sure there is no multiple myeloma), vitamin D level (a low
level causes trouble with getting calcium to your bones), thyroid function (high thyroid function can cause
osteoporosis), and antibodies for celiac disease- a condition that may cause poor intestinal absorption of
important nutrients. A simple “fasting second-void morning urine” specimen shows the rate of bone metabolism
or “turnover”- an important factor in determining bone density and bone strength. With this test, natural bone
protein products such as N-telopeptide (NTX) are tested. X-rays may detect previous fractures of the spine,
which can occur with or without back pain and may result in loss of height. Sometimes a nuclear bone scan
can identify other kinds of bone disease that cause fractures. In rare cases, a bone biopsy provides helpful
information. Other tests may be necessary depending on your particular situation.

How are the tests done?

If a 24-hour urine collection is ordered, please go to the lab to get a container for the urine collection and carefully
follow the instructions on the other side of this page. If blood tests are ordered, you must have nothing to eat or
drink (except water) after midnight, and be at the lab about 8:00 AM. If a “fasting second-void morning urine”
specimen for NTX is ordered, you must have nothing to eat or drink (except water) after midnight, and be at
the lab about 8:00 AM. Urinate at home before you go to the lab, and plan on giving the lab a fresh urine specimen
when you are there.

If all three types of tests are ordered, you may combine them in one of the following ways:

• When you give your 24-hour urine container to the lab at 8:00 AM, you can also have a fasting blood
  specimen drawn and give them a fresh urine specimen, or Go to the lab for a fasting blood test and
  second void urine specimen first, and they will then give you a container for doing the 24-hour urine
  collection later.
  
  Instructions for 24-Hour Urine Collection
  
  Use the urine collection container that you picked up at the lab. If you normally drink a very large amount
  of water every day, ask for an extra container in case you completely fill the first one. Plan on doing the
  urine collection on a day that is convenient for you, considering that you must bring the container of urine
  to the lab for testing the following day. Those who work on weekdays may find it easiest to do the collection
  on a Sunday. For this test to be accurate, you must collect all of the urine produced in 24-hours according to
  these directions. If your schedule or lifestyle makes it impossible to begin and end the collection at 7:00 AM,
  then you may select another time, but you must still collect all urine produced for the entire 24-hours. If you
  have any questions about the collection, call the lab for more information.

1. Drink the usual amount of liquids, eat your normal diet, and take the usual vitamins, calcium, and medications
   during the collection period. Do not drink any alcohol during the collection period.
   
2. Start the 24-hour period at exactly 7:00 AM by urinating into the toilet to eliminate the urine produced by your
   kidneys overnight.
   
3. Collect all urine produced after 7:00 AM in the container until the following morning.
4. At 7:00 AM the next morning, complete the collection by emptying your bladder into the container.
   
5. During the 24-hour collection period, keep the urine in the refrigerator or on ice. Urine at room temperature may
   grow bacteria which could spoil the collection.
   
6. If you forget to collect any of your urine during the 24-period, you must discard what you have collected, clean
   and dry the container, and start over.
   
7. Label the container with your name, date of birth, date and time of beginning the collection, and the name of the
   ordering physician.
   
8. Deliver the container to the lab with the requisition form as soon as possible after the collection period is complete.

E. Michael Lewiecki, MD                                    
Lance A. Rudolph, MD

This page update 01/10/08