One of many primary ideas of the Higher Bones Program® is that every one osteoporosis, all extreme bone loss, or all actual elevated danger of low-trauma fracture has a trigger. To higher 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 check, we propose that our shoppers focus on the next exams with their physician to see which of them are applicable. Under are examples of exams that might be useful and the fundamentals of what the check outcomes imply so to higher focus on your private state of affairs along with your physician. (Get a printable model of those exams right here to convey to your docs)……then be part of us for the webinar that explains these medical exams for osteoporosis!
- Vitamin D 25(OH)D blood check (Accessible At-House)
- Ionized calcium check *
- Intact parathyroid hormone blood check (iPTH)*
- 24-hour urine calcium excretion check *
- Thyroid hormone perform check (TSH)*
- N-telopeptides crosslinks (NTx) urine marker of bone resorption check*
- N-telopeptides crosslinks (NTx) serum marker of bone resorption check*
- Dpd urine marker of bone resorption check (deoxypyridinium crosslinks check)
- Vertebral deformity evaluation
- Free cortisol check (blood or saliva)*
- DHEA check (blood or saliva)*
- C-reactive protein check (excessive sensitivity if attainable)*
- Homocysteine check (plasma or serum)*
- Celiac illness and gluten sensitivity check*
- Intercourse hormone check*
- Omega 3 Index (Accessible At-House)
*A few of these exams can be found from a self pay service that has partnered with eth Higher Bones Basis. In case you are unable to entry these check out of your Dr. observe to the top of the weblog for extra data.
Checks to assist reveal what causes osteoporosis
Vitamin D 25(OH)D blood check
This check determines your blood degree of vitamin D. The outcomes let you know the quantity of vitamin D supplementation wanted to achieve a therapeutic blood degree of vitamin D, which is vital for satisfactory calcium absorption and primary bone help.
What your outcomes let you know: The reported “regular” vary may be very vast, typically from 30 to 100 ng/mL. We now know that something lower than 32 ng/mL is more likely to severely restrict calcium absorption and result in bone loss. On the Middle for Higher Bones, we try for a 50-70 ng/mL blood degree of 25(OH)D.
Ionized calcium check
This can be a easy blood check to measure the extent of free calcium — that’s, the metabolically lively portion of calcium not certain to proteins within the blood. This check isn’t meant to evaluate the appropriateness of your calcium consumption as a lot as it’s meant as an oblique check of parathyroid functioning (see under). It will probably additionally not directly inform us some issues about vitamin D standing.
What your outcomes let you know: 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 attainable oblique indicator of extreme parathyroid hormone exercise. A low ionized calcium degree is perhaps associated to low albumin and low protein standing.
Intact parathyroid hormone blood check (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 let you know: On the Middle for Higher Bones, we search for an intact parathyroid hormone degree inside the regular vary established by the actual testing laboratory. Two frequent causes of an excessively excessive parathyroid hormone degree are vitamin D deficiency (which is well corrected with correct vitamin D3 supplementation and monitoring); and an overactive parathyroid, which is most frequently as a result of benign tumors on the parathyroid glands. Correction of this example typically 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 greatest handled by an endocrinologist.
24-hour urine calcium excretion check
This check appears at how a lot calcium is being excreted within the urine. For this check, you accumulate 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 typical reason behind bone loss and osteoporosis.
What your outcomes let you know: The traditional laboratory vary for an individual consuming a mean eating regimen is round 100 to 250 mg of calcium misplaced within the urine every day. I contemplate 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 needs to be taken to cut back this lack of calcium within the urine, as it may possibly trigger bone loss. Dietary, life-style, and medical approaches will help.
Thyroid hormone perform check (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 implies that the thyroid isn’t producing sufficient T3 and T4, so checking your TSH degree is a straightforward manner of screening for an underactive thyroid. Thyroid hormone ranges which might be too excessive or too low can contribute to osteoporosis, as can a dose of thyroid remedy that’s too excessive. To display for overactive thyroid, or to ensure your dose of thyroid medicines isn’t too excessive for those who’re already being handled for hypothyroidism, you’ll want exams without cost T3 and free T4.
What your outcomes let you know: The frequent laboratory vary for all adults is 0.35 to five.50 and a extra supreme degree 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 reveals up within the urine and blood in elevated quantities. On the Middle for Higher Bones, we typically use the N-telopeptides crosslinks (NTx) urine check, however there are a number of others out there. One generally used check is the urine Dpd check (deoxypyridinium crosslinks check). There’s additionally an NTx serum check and the CTX serum check.
As there could be an excessive 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 check.
N-telopeptides crosslinks (NTx) urine marker of bone resorption check
What your outcomes let you know: The check consequence “regular” vary typically listed on the check report may be very broad. For instance, check studies from our native lab record the premenopausal regular vary for girls 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 vast to be helpful.
Ideally, a lady want to have an NTx degree close to that of the typical premenopausal lady, which within the urine is round 35, however ranges typically soar into the 60s to 80s or increased in and round menopause. For grownup males, the imply NTx is 27, which is a extra supreme worth than the upper numbers. Additionally, these markers can get very excessive in uncommon ailments corresponding 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 check from Osteomark to guage the success of our bone constructing program. We glance to convey the urine NTx degree right down to the 40’s, which usually signifies that bone breakdown has normalized. There are some instances, nonetheless, the place bone breakdown may be very low, however bone build-up is even decrease. This situation, generally known as “low turnover osteoporosis,” is detected when an individual has a low NTx, however remains to be shedding important bone (5-6%) as seen on bone density testing.
N-telopeptides crosslinks (NTx) serum marker of bone resorption check outcomes
What your outcomes let you know: 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 commonly listed as 5.4-24.2 nM BCE/L, with a imply of 14.8. Once more, this vary is just too vast to be helpful for us on the Middle for Higher Bones. We search for a results of 12 or considerably decrease in ladies, and 14 or considerably decrease in males.
Dpd urine marker of bone resorption check (deoxypyridinium crosslinks check)
What your outcomes let you know: This bone resorption check additionally lists a broad vary of regular values — for girls, 3.0 to 7.4 nM/mM and for males 2.3 to five.4 nM/mM. Clinically, grownup ladies ought to attempt for a Dpd check rating within the 4s, and in males an excellent degree would doubtless be considerably decrease.
Vertebral deformity evaluation
That is one other x-ray check for bone that photos every vertebral physique of the backbone and appears to see if there are deformities or fractures. The Vertebral Deformity Evaluation could be achieved on newer bone density testing machines, with particular software program that takes a “lateral” view of the backbone.
What your outcomes let you know: 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 check (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 symbolize a serious danger issue for osteoporosis and low-trauma fractures. This check could be achieved with blood or saliva.
What your outcomes let you know: Cortisol is the “rise up and go” hormone that ought to rise within the early morning and decline through the day. Thus, check outcomes differ by what time of day the check was taken. Testing labs will give their regular vary readings and the timing of the check needs to be taken into consideration when decoding check outcomes.
DHEA check (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 will help keep youthful DHEA degree as we age. Low ranges of DHEA are a danger issue for osteoporosis. This check additionally could be achieved with blood or saliva.
What your outcomes let you know: In saliva testing, the outcomes are sometimes correlated with the outcomes of the cortisol testing. It’s also typically measured as DHEA-S, that’s, DHEA in its sulfated type. Once more, every lab will supply its regular vary relying on the check used.
C-reactive protein check (excessive sensitivity if attainable)
C-reactive protein is a plasma protein that’s held to be a marker of common irritation inside the physique. It’s a recognized danger issue for coronary heart illness as a result of coronary heart illness is basically an inflammatory dysfunction. Osteoporosis can also be inflammatory in nature and this check is useful in detecting undesirable irritation, which can contribute to bone well being issues.
What your outcomes let you know: Typically, within the C-reactive protein (or CRP) check, the decrease the rating the much less irritation and thus the higher studying. I search for a excessive sensitivity CRP degree lower than 1.0mg/dL.
Homocysteine check (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 satisfactory B nutritional vitamins, homocysteine can accumulate within the physique. Excessive ranges of this substance injury collagen and symbolize highly effective danger elements for each heart problems and for osteoporotic fractures.
What your outcomes let you know: Regular ranges of homocysteine within the blood vary from 5 to fifteen mM/L. On the Middle for Higher Bones we wish to see a homocysteine degree of 8 or under.
Celiac illness and gluten sensitivity check
Celiac illness, and even simply sensitivity to gluten, can result in irritation of the intestine. This irritation is expounded to a fancy inflammatory cascade which might enhance bone loss. Additionally, these with celiac illness undergo from weak digestion and malabsorption of many vitamins together with nutritional vitamins A, Ok, and D. These deficiencies in flip injury bone. If there’s any suggestion of gluten sensitivity or celiac illness, applicable testing needs to be thought-about
What your outcomes let you know: There are various exams used to assist decide if one is affected by gluten intolerance or the autoimmune situation generally known as celiac illness. Discuss along with your healthcare practitioner about what is perhaps best for you.
Intercourse hormone check outcomes
Put up-Menopausal Females: Progesterone, Estrogen
Feminine intercourse hormones drop naturally at menopause amongst all ladies, so I don’t typically counsel testing of those hormones. These eager about this sort of hormone testing, or these taking hormone substitute medicines, needs 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 crucial to bone well being. Low ranges of both estrogen or progesterone can restrict improvement of optimum peak bone mass. Irregular, or continuously missed, durations needs to be studied by a educated doctor.
In keeping with famous progesterone researcher, endocrinologist Dr. Jerilynn Prior, some 25% of younger ladies within the US and Canada fail to develop optimum peak bone mass as a result of undetected ovulatory disturbances which end in low progesterone ranges. Testing of estrogen and progesterone could be useful in pre-menopausal ladies with a bone well being concern.
Each blood and saliva testing can be found for pre-menopause intercourse hormone testing. Every testing laboratory may have its vary of regular intercourse hormone check 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 nearly at all times features a check for testosterone. Apparently sufficient, estrogen additionally performs a task in male bone well being and at instances the physicians will check for estrogen in males with osteoporosis.
Each blood and saliva testing can be found for intercourse hormone exams in males. Every testing laboratory may have its vary of regular intercourse hormone check outcomes.
Omega-3 Index+ At-home check
This can be a easy at-home blood check 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
check will clarify what different fatty acid ranges can (or can’t) let you know 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 eating regimen.
As soon as your blood ranges, you possibly can modify your eating regimen and alter your blood
ranges in as little as 3-4 months
What your outcomes let you know:
As part of an total wholesome life-style, an Omega-3 Index
within the 8-12% vary could assist to take care of 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 danger of
deadly coronary heart assaults, a 34% decrease danger of dying from any trigger, and a 4.7 12 months enhance in
extra life expectancy compared with the typical 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 grow to be a knee-jerk response of “see a symptom, take a capsule.” However we on the Middle for Higher Bones imagine 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 scary!), 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 shoppers and readers that their MDs usually are not prepared to order the exams that they request. That is such a frequent incidence that we needed to discover a manner for girls to acquire these obligatory 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 straightforward . . .
#1 Choose the exams that you’re eager about and submit your type under. Be sure to embody your full deal with with metropolis, state, and zip code. We are going to go this data on to the lab in your behalf.
#2 Watch for an e mail from Evexia Lab along with your username and password (additionally verify your spam folder). When you log in you’ll then be capable of see the price of the exams and may select to self pay (no insurance coverage accepted). After you pay Evexia will e mail you a requisition type for the lab.
#3 Print your requisition and take it to the closest Labcorp facility. You could find a Labcorp near you utilizing this hyperlink: https://www.labcorp.com/labs-and-appointments. Self-pay testing isn’t out there in NY, NJ, and RI.
#4. In 2 to 4 weeks after getting the exams achieved, you’ll obtain your lab outcomes through an e mail notifying you that the outcomes are prepared. They are often considered in your account or you possibly can print them out and take them to your physician for interpretation.