Scans - these tests give you a snapshot in time about your bone health

  • Dexascan of lumbar spine, hip(s) and distal radius (forearm near wrist): measures bone density
  • Trabecular bone score: measures quality of bone - this is an interpretation of the dexascan results that not all facilities offer
  • Vertebral fracture assessment: uses same machine as dexascan, but looks at additional vertebrae to assess for compression and other fractures. This is not as sensitive as an X-ray, but is considerably less radiation.

Lab tests - these tests tell you what is going on in your body NOW

Margie Bissinger interviews Dr. Kim Millman on essential testing for secondary causes of osteoporosis

Request Dr. Millmans interactive tool kit

Please make sure that your lab report is using the same units as listed below. If not, do a search for how to convert.

General assessment of level of bone building and bone breakdown. These tests should be done as early in the morning as possible (but always at the same time if you are repeating a test). You should be fasting and refrain from biotin (in many supplements and multi-vitamins), collagen, bone broth and heavy exercise for 48 hours. These tests are useful for: assessing your current status and for determining whether a medication is working. If starting a medication, it is important to get baseline (pre-treatment) values.

  • C-telopeptide (CTX): The C-telopeptide is released from bone collagen as the bone is broken down. This test is a measurement of bone breakdown. The "normal range" for CTX on a lab report is overly broad since it includes results from patients who are actively losing bone. Functional medicine recommends a range of 250-350 pg/ml. According to Dr. Millman, if your result is over 450 pg/mL, you are almost certainly losing bone.
  • Propeptide of Type I Collagen (P1NP). This propeptide is a precursor to the collagen that is incorporated into your bone and therefore is a measurement of active bone building. Dr. Millman recommends an optimal range of 30 - 80 ng/mL.

Parathyroid Hormone (PTH), 25(OH) vitamin D, and calcium. These 3 labs need to be done from the same blood draw. Vitamin D and PTH together work to maintain your blood calcium levels in a very narrow range. see [page to be added] for a detailed description. General guidelines for optimal levels (again from Dr. Millman):

  • Calcium (from complete metabolic panel): 9.2 - 10.0 mg/mL
  • Parathyroid Hormone (PTH): 15 - 65 pg/mL
  • 25-OH Vitamin D: 50 - 80 ng/mL

Although there are some clearly abnormal PTH levels, in general you need to analyze these 3 together. When blood calcium levels are low, PTH and vitamin D work together to increase the level. This includes drawing calcium from your bones (99% of the body's calcium is stored in bone), increasing intestinal absorption, and increasing kidney reabsorption. Abnormal PTH response (typically due to a benign parathyroid tumor) is a significant cause of secondary osteoporosis. To assess these 3 labs together, see Norman Parathyroid Center or Southwest Parathyroid Center. The Norman Parathyroid Center produces a free app (Calcium Pro) available on both Apple and Android operating systems.

Are you losing excessive amounts of calcium in your urine? When calcium levels are low, PTH should direct the kidneys to reasbsorb calcium from the urine (meaning take it out of urine and put it back in the blood). The optimal amount to excrete per 24 hours is

  • women: 100 - 250 mg/day
  • men: 100 - 300 mg/day

Functional tests for iron, vitamin B9 (folate) and B12 (cobalamin) deficiencies

  • MCV (part of CBC blood panel). MCV is the Mean Corpuscular (red blood cell) volume.
  • optimal range is 88 - 92 fL (femtoliters)
  • high MCV values indicate either a vitamin B12 (cobalamin) or B9 (folate) deficiency or heavy alcohol use. In the absence of heavy alcohol use, if you are taking a supplement containing B12 and B9, this may mean that you have a defective MTHFR gene. The product of this gene is responsible for converting these vitamins to their active form by methylating them. There are supplements (either as a multi-vitamin or individual vitamins) that provide these vitamins in their methylated form
  • low MCV values may indicate an iron deficiency.

Bone Buddies