• Clinical science

Laboratory evaluation of bone disease


Laboratory evaluation of serological and urinary markers is important in the diagnosis of suspected bone disease. An increase or decrease in calcium, phosphate, creatinine, or parathormone may provide important information for differential diagnosis. Elevated serum alkaline phosphatase, which originates from several tissues (e.g., liver and bone) indicates increased bone formation (e.g., after a pathological fracture, in bone metastasis, or Paget disease), once liver disease is ruled out. Elevated urinary hydroxyproline, a specific marker of collagen synthesis and breakdown, is a typical finding in patients with Paget disease.


Serum calcium Serum phosphate Parathormone (PTH) Additional lab values
Osteoporosis n n n
Osteomalacia and Rickets n/↓
Paget disease n n n
Primary hyperparathyroidism
  • Hypercalciuria

Secondary hyperparathyroidism/renal osteodystrophy

Tertiary hyperparathyroidism
Osteolytic metastasis n/↓ n/↓