Osteoporosis

Osteoporosis is a condition where bones become weak and break more easily—often after a minor fall or even a cough. Bone loss accelerates with agingmenopause, certain medications (e.g., long-term steroids), and medical conditionsthat affect hormones or nutrient absorption. While diagnosis relies on bone density imaging (DXA)blood and urine tests are essential to evaluate osteoporosis risk, bone metabolism, and secondary causes (issues that make bones lose mineral faster than expected).

Ulta Lab Tests provides convenient access to vitamin D, calcium/phosphorus, parathyroid hormone (PTH), thyroid tests, bone turnover markers (CTX, NTX, P1NP, osteocalcin) and more—helping you and your clinician screen, investigate causes, and monitor bone health.


Signs & Symptoms (When to consider testing)

  • Fracture clues: wrist, hip, or spine “fragility” fractures; height loss; sudden back pain (possible vertebral compression).

  • Skeletal symptoms: chronic back or hip pain; stooped posture (kyphosis).

  • Risk history: menopause, age >50 with fracture, low body weight, smoking, heavy alcohol use, long-term glucocorticoids, or low physical activity.

  • Medical conditions: thyroid or parathyroid disorders, celiac disease, malabsorption, chronic kidney/liver disease, hypogonadism (low sex hormones), vitamin D deficiency.

  • Family history: parent with hip fracture or known osteoporosis.

Related searches: osteoporosis blood tests, bone turnover markers, vitamin D test, calcium and PTH, secondary osteoporosis workup, bone metabolism labs, fragility fractures.


Why These Tests Matter

What osteoporosis labs can do

  • Identify secondary causes of bone loss (e.g., low vitamin Dhyperparathyroidismthyroid excessmalabsorptionCKD).

  • Measure bone turnover to understand how fast bone is breaking down or being rebuilt.

  • Provide baseline and trend data to complement DXA results and clinical exams.

What they cannot do

  • Diagnose osteoporosis by themselves or quantify bone density—DXA is required for that.

  • Replace imaging when a fracture is suspected.


What These Tests Measure (at a glance)

  • 25-Hydroxy Vitamin D [25(OH)D]: main indicator of vitamin D status—low levels are common and impair calcium absorption.

  • Calcium & Phosphorus: minerals critical to bone; abnormal values can signal endocrine or kidney causes.

  • Intact PTH (Parathyroid Hormone): high levels can drive bone loss (hyperparathyroidism)—often checked with calcium.

  • Alkaline Phosphatase (total or bone-specific): enzyme linked to bone formation; may be elevated in high turnover.

  • Bone Turnover Markers:

    • CTX/NTX (resorption): reflect bone breakdown rate.

    • P1NP (formation) & Osteocalcin (formation): reflect bone building.

  • Comprehensive Metabolic Panel (CMP): kidney/liver context; albumin (for corrected calcium).

  • TSH/Thyroid hormones: screens for overactive thyroid, a reversible cause of bone loss.

  • Magnesium and Phosphate: support mineral metabolism.

  • Celiac screen (tTG-IgA ± total IgA): checks for malabsorption contributing to low bone density.

  • Sex hormone evaluation (when indicated): Testosterone in men; FSH/estradiol context in women.

  • 24-Hour Urine Calcium: helps distinguish causes of hypercalcemia or evaluate calcium handling.

Note: Bone turnover markers can vary by time of day and recent meals; morning collection and following test prep instructions improve consistency.


How the Testing Process Works

  1. Order online: choose an osteoporosis/secondary-cause panel or individual markers.

  2. Visit a nearby lab: quick blood draw (and urine, if ordered).

  3. Get results fast: most post within 24–48 hours in your secure account.

  4. Review with your clinician: combine lab findings with DXA results, history, and exam.


Interpreting Results (general guidance)

  • Low 25(OH)D → supports vitamin D deficiency, a common contributor to bone loss.

  • High PTH with abnormal calcium → consider hyperparathyroidism (secondary cause of osteoporosis).

  • High bone turnover (↑CTX/NTX, ↑P1NP/osteocalcin) → suggests faster bone remodeling; useful for baselineand trend monitoring.

  • Abnormal TSH → thyroid imbalance may accelerate bone loss.

  • Abnormal CMP (creatinine, liver enzymes) → kidney/liver disease can affect bone and mineral balance.

Always interpret labs with a qualified healthcare professional. Labs complement, not replace, DXA imaging.


Choosing Panels vs. Individual Tests

  • First look (unexplained low bone density or fracture): Vitamin D + Calcium/Phosphorus + PTH + CMP + TSH.

  • If rapid loss or high turnover suspected: add CTX/NTX and P1NP/osteocalcin.

  • If malabsorption suspected: add celiac screen; consider magnesium and phosphate.

  • Men with low bone density: add morning total testosterone per clinician guidance.

  • Monitoring: repeat selected markers (e.g., 25(OH)DCTX/P1NP) at intervals recommended by your clinician.


FAQs

What blood tests check for osteoporosis?
Key labs include vitamin D, calcium, phosphorus, PTH, thyroid tests, and bone turnover markers (CTX, NTX, P1NP). They look for causes and activity, while DXA measures bone density.

Can blood tests diagnose osteoporosis?
No. DXA scans diagnose osteoporosis. Labs identify why bone may be weak and help monitor changes over time.

Do I need to fast for bone turnover markers?
Some markers vary with meals and time of day. Morning collection and following the prep instructions on your order are recommended.

What is a secondary cause of osteoporosis?
A medical issue that speeds bone loss—examples include low vitamin Doveractive thyroidhigh PTHceliac disease, or chronic kidney disease.

How quickly are results available?
Most tests are ready within 24–48 hours; some specialized markers may vary.

Do I need DXA if my labs are abnormal?
Yes. DXA is still needed to confirm bone density and track fracture risk.


Internal Links & Cross-References

  • Bone & Joint Tests Hub

  • Osteoarthritis

  • Rheumatoid Arthritis

  • Ankylosing Spondylitis

  • All Bone & Joint Tests

  • Key Lab Tests: 25-Hydroxy Vitamin D • Calcium • Phosphorus • PTH • Alkaline Phosphatase (Bone-Specific) • CTX • NTX • P1NP • Osteocalcin • CMP • TSH • Magnesium • Celiac Antibodies (tTG-IgA)


Available Tests & Panels

Tip: Start with a secondary-cause screen (25[OH]D, Calcium/Phosphorus, PTH, CMP, TSH). Layer in bone turnover markers to establish a baseline and track trends.

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The Bone Specific Alkaline Phosphatase Test evaluates levels of BSAP, an enzyme produced by osteoblasts during bone formation. Abnormal results may reflect osteoporosis, Paget’s disease, rickets, or other metabolic bone disorders. This test supports assessment of bone turnover, skeletal remodeling, and overall bone health, offering valuable information about metabolic activity in musculoskeletal function.

Blood
Blood Draw

The Collagen Type I C-Telopeptide (CTX) Test measures CTX fragments released during bone breakdown, making it a key marker of bone resorption. Elevated levels may indicate osteoporosis, metabolic bone disease, or increased fracture risk. Doctors order this test to monitor bone loss, evaluate treatment for osteoporosis, or assess bone health in postmenopausal women. Results provide vital insight into bone turnover and long-term skeletal health management.

Blood
Blood Draw
Also Known As: CTx Test

The Serum Protein Electrophoresis (SPEP) Test separates proteins in blood into albumin and globulin fractions to detect abnormal patterns. Doctors order this test to evaluate multiple myeloma, Waldenström’s macroglobulinemia, amyloidosis, or chronic infections. Abnormal results may indicate monoclonal gammopathy or immune disorders. Results provide essential insight into protein balance, immune function, and blood-related cancers, guiding diagnosis and monitoring.

Also Known As: SPEP Test, Protein Total and Electrophoresis Test, Protein ELP Test, SPE Test, Serum Protein Electrophoresis Test

The Collagen Cross-Linked N-Telopeptide (NTx) 24 Hour Urine Test measures breakdown products of type I collagen, the main protein in bone. Elevated levels reflect increased bone resorption, which may be linked to osteoporosis, metabolic bone disease, or treatment monitoring. This test provides valuable insight into bone turnover, helping evaluate bone health, response to therapy, and risk of skeletal disorders.

Urine
Urine Collection
Also Known As: NTx Test

The Collagen Cross-Linked N-Telopeptide Urine Test measures type I collagen breakdown products to evaluate bone resorption and skeletal health. Elevated levels may indicate osteoporosis, metabolic bone disease, or increased bone turnover, while lower levels may reflect treatment response. This test provides insight into bone metabolism, helping clinicians assess risk of fractures, monitor therapy, and track long-term bone health.

Urine
Urine Collection
Also Known As: NTx Test

The Osteocalcin N-MID Test evaluates blood levels of osteocalcin, a marker of bone formation secreted by osteoblasts. Abnormal values may reflect osteoporosis, metabolic bone disease, or hormonal influences on bone remodeling. As a sensitive indicator of bone turnover, this test helps track skeletal health, monitor treatment effectiveness, and support early detection of disorders affecting bone density and metabolism.

Blood
Blood Draw

The Complete Blood Count with Differential and Platelets Test is a comprehensive blood test that checks red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The differential analyzes types of white blood cells to detect infections, anemia, clotting abnormalities, immune conditions, and certain cancers. This essential test is often ordered for routine health exams, diagnosis, and monitoring treatment progress.

Blood
Blood Draw
Also Known As: CBC Test, CBC with Differential and Platelets Test, CBC w/Diff and Platelets Test, Full Blood Count Test, Complete Blood Count Test

The Estrogen Total Test measures all forms of estrogen in blood, including estradiol, estrone, and estriol, to assess reproductive and hormonal health. Abnormal levels may indicate menstrual irregularities, menopause status, infertility, or hormone-related disorders. Doctors order this test to evaluate fertility, monitor hormone therapy, and investigate symptoms such as hot flashes, irregular cycles, or abnormal bleeding. It provides key insight into endocrine and reproductive function.

Blood
Blood Draw
Also Known As: Total Estrogen Test, Estrogen Serum Test

Most Popular

The T3 Reverse (rT3) Test measures reverse triiodothyronine, an inactive thyroid hormone, to assess thyroid and metabolic function. High rT3 may occur in hypothyroidism, chronic illness, stress, or during certain treatments, while low levels may reflect hormone imbalance. Doctors use this test along with TSH, Free T4, and Free T3 to evaluate fatigue, weight changes, or slow metabolism. The rT3 Test provides insight into thyroid regulation, energy balance, and endocrine health.

Blood
Blood Draw
Also Known As: Reverse T3 Test, RT3 Test, T3R Test

Most Popular

The T3 Total Test measures total triiodothyronine (T3), a combination of both bound and unbound (free) T3, to assess thyroid function. Abnormal levels may indicate hyperthyroidism, hypothyroidism, goiter, or pituitary disorders. Doctors use this test to evaluate symptoms like fatigue, weight changes, anxiety, or irregular heartbeat and to monitor thyroid treatment. The T3 Total Test provides essential insight into metabolism, energy regulation, and overall endocrine health.

Also Known As: Total T3 Test, Total Triiodothyronine Test, T3 Test, Bound and Unbound T3

Most Popular

The T3 Free Test measures free triiodothyronine (T3), the active thyroid hormone not bound to proteins, to assess thyroid function. It helps diagnose hyperthyroidism, hypothyroidism, goiter, and pituitary disorders. Doctors order this test to evaluate symptoms like fatigue, weight changes, anxiety, or irregular heartbeat and to monitor thyroid replacement or antithyroid therapy. The Free T3 Test provides key insight into metabolism, energy regulation, and overall endocrine health.

Blood
Blood Draw
Also Known As: Free T3 Test, Free Triiodothyronine Test, FT3 Test, T3F Test, Unbound T3 Test

Most Popular

The T4 Total Test measures total thyroxine (T4) in blood, a combination of both bound and unbound (free) T4, to assess thyroid function. Abnormal levels may indicate hypothyroidism, hyperthyroidism, goiter, or pituitary disorders. Doctors use this test to evaluate symptoms like fatigue, weight changes, hair loss, or irregular heart rate and to monitor thyroid replacement or antithyroid therapy. The T4 Total Test provides key insight into metabolic, hormonal, and endocrine health.

Also Known As: Total T4 Test, Total Thyroxine Test, T4 Test, Bound and Unbound T4 Test

Most Popular

The T4 Free Test measures the level of free thyroxine (T4) in blood, the active thyroid hormone not bound to proteins. It helps diagnose thyroid disorders such as hypothyroidism, hyperthyroidism, and goiter, as well as pituitary conditions affecting hormone regulation. Doctors use this test to evaluate symptoms like fatigue, weight changes, hair loss, or irregular heartbeat and to monitor thyroid replacement or antithyroid therapy, providing insight into metabolic and endocrine health.

Blood
Blood Draw
Also Known As: Free T4 Test, Free Thyroxine Test, FT4 Test, T4F Test, Unbound T4 Test

The Testosterone Free and Total Test measures total testosterone and free, bioavailable testosterone in blood for both men and women. It helps diagnose hormone imbalance, infertility, low libido, erectile dysfunction in men, irregular periods, or PCOS in women. Doctors also order it to assess fatigue, mood changes, or muscle weakness and to monitor hormone therapy. This test provides key insight into reproductive, endocrine, and overall metabolic health.

Blood
Blood Draw
Also Known As: Bound and Unbound Testosterone, Uncapped Testosterone Test

The Testosterone Free, Bioavailable, and Total Test measures total testosterone, free testosterone, and bioavailable testosterone, along with sex hormone binding globulin (SHBG) and albumin. This test provides a complete evaluation of hormone balance in men and women. Doctors use it to assess infertility, erectile dysfunction, low libido, PCOS, fatigue, or muscle loss and to monitor hormone therapy. Results offer key insight into reproductive, endocrine, and metabolic health.

Blood
Blood Draw
Also Known As: Bound Unbound and Bioavailable Testosterone with SHBG Test, Uncapped Testosterone

The Testosterone Free and Total and Sex Hormone Binding Globulin (SHBG) Test measures total testosterone, free testosterone, and SHBG to assess hormone balance in men and women. It helps diagnose infertility, erectile dysfunction, low libido, irregular periods, PCOS, and abnormal puberty. Doctors also use it to evaluate fatigue, muscle weakness, or mood changes and to monitor hormone therapy. This test provides a comprehensive view of reproductive, endocrine, and metabolic health.

Also Known As: Bound and Unbound Testosterone with SHBG Test, Uncapped Testosterone Test

The Testosterone Total Male Test measures testosterone levels in men to assess reproductive, sexual, and hormonal health. It helps diagnose low testosterone (hypogonadism), infertility, and erectile dysfunction. Doctors use it to evaluate fatigue, muscle loss, or low libido and to monitor testosterone therapy, hormonal balance, bone health, and overall metabolism.

Patient must be male and 18 years of age or older.
Blood
Blood Draw
Also Known As: Total Male Testosterone Test

The Thyroid Peroxidase and Thyroglobulin Antibodies Test measures TPO and TgAb antibodies that target thyroid enzymes and proteins essential for hormone production. High levels are linked to autoimmune thyroid disorders such as Hashimoto’s thyroiditis and Graves’ disease. Doctors order this test to evaluate fatigue, weight changes, neck swelling, or irregular heartbeat and to confirm thyroid autoimmunity. It provides vital insight into thyroid function and endocrine health.

Also Known As: Thyroid Antibodies Test, TPO and TgAb Test

Most Popular

The Thyroid Stimulating Hormone (TSH) Test measures TSH levels in blood to assess thyroid function and diagnose hypothyroidism or hyperthyroidism. It evaluates how the thyroid controls metabolism, energy, weight, and heart rate. Doctors use the TSH test to investigate symptoms such as fatigue, hair loss, or mood changes. Frequently included in routine health exams, it is also key for monitoring thyroid disease treatment and overall endocrine balance.

Blood
Blood Draw
Also Known As: Thyroid Stimulating Hormone Test, Thyrotropin Test

Most Popular

The Thyroid Stimulating Immunoglobulin (TSI) Test detects antibodies that stimulate the thyroid gland, often causing hyperthyroidism and Graves’ disease. High TSI levels may lead to symptoms such as weight loss, rapid heartbeat, or eye problems. Doctors order this test to confirm Graves’ disease, monitor treatment, or assess relapse risk. Results provide essential insight into autoimmune thyroid disorders and guide personalized management strategies.

Blood
Blood Draw
Also Known As: Thyroid Stimulating Immunoglobulin Test

The Iron Total and Total Iron Binding Capacity (TIBC) Test measures iron levels in blood along with the blood’s ability to transport iron. It helps diagnose iron deficiency anemia, iron overload (hemochromatosis), and monitor nutritional or chronic health conditions. Low iron or high TIBC may indicate anemia, while high iron or low TIBC can suggest overload. Doctors use this test to evaluate fatigue, weakness, or other symptoms linked to iron and metabolic health.

Blood
Blood Draw
Also Known As: Serum Iron Test, Total Iron Binding Capacity Test, TIBC Test, UIBC Test

The Iron Micronutrient Test measures blood iron levels to evaluate nutritional status and detect deficiencies or excess. Iron is essential for hemoglobin production, oxygen transport, energy metabolism, and immune function. This test helps identify anemia, iron overload, absorption issues, or dietary imbalances, supporting diagnosis and management of overall health and vital body functions.

Patient must be 18 years of age or older.
Blood
Blood Draw
Also Known As: Serum Iron Test, Serum Fe Test

Most Popular

The Iron Total Test measures iron levels in blood to evaluate nutritional status, red blood cell production, and overall metabolic health. Abnormal levels may indicate iron deficiency anemia, chronic blood loss, or poor absorption, while high levels may suggest hemochromatosis, liver disease, or iron overload. Doctors use this test to investigate fatigue, weakness, or pallor and to monitor treatment. Results provide key insight into anemia and iron balance.

Blood
Blood Draw
Also Known As: Serum Iron Test, Serum Fe Test

The Mineral Micronutrients Test Panel measures minerals: Calcium, Chromium, Copper, Iron, Magnesium RBC, Manganese, Molybdenum, Selenium, and Zinc to assess nutritional balance and overall health. These minerals are essential for bone strength, metabolism, energy production, antioxidant defense, and immune function. The panel helps detect deficiencies, excesses, or absorption issues, guiding health management.

Patient must be 18 years of age or older.

Most Popular

The Ferritin Test measures ferritin, a protein that stores iron in the body, to evaluate iron levels and detect deficiency or overload. It helps diagnose anemia, iron deficiency, hemochromatosis, and chronic disease-related inflammation. Doctors often order the ferritin test to investigate fatigue, weakness, or unexplained symptoms. It is also used to monitor iron supplementation, treatment effectiveness, and overall iron metabolism health.

Blood
Blood Draw
Also Known As: Iron Storage Test

Early Intervention can Slow Osteoporosis. Get the Information you Need With an Osteoporosis Test.

Osteoporosis is a common condition that afflicts millions of Americans each year. If undetected, osteoporosis can make sufferers more susceptible to debilitating bone fractures. Early diagnostic testing can enable individuals to take steps to manage their osteoporosis, potentially reducing the rate of decline. 

Here we look at what osteoporosis is, alongside consideration of the lab tests that can be used to diagnose it.

What is Osteoporosis?

Osteoporosis is the process of reducing bone density. Osteoporosis can occur in any bone in the body. For a variety of reasons (some of which are discussed below), the normal reabsorption of bone cells by osteoclasts (specialist cells) isn't matched by the production of fresh bone cells from osteoblasts. The result is a net reduction in bone density.

About Osteoporosis

Osteopenia, or bone density, is the pre-cursor to osteoporosis.  Osteopenia is diagnosed when bone density tests show an individual has a lower bone density than average for their age, but not so low that they are suffering from osteoporosis. Osteopenia doesn't invariably lead to osteoporosis. If caught and treated, osteopenia can be slowed.

The loss of bone density is a natural process, which can be accelerated by various pathologies. Bone density starts to naturally decline from the 30s onward. It occurs in both genders but is usually more pronounced in post-menopausal women. The fact that there are no symptoms of osteoporosis in the early stages makes it difficult to spot.

Risk Factors for Osteoporosis

Several natural and pathological risk factors increase the chances of developing osteoporosis. Some of these include:

  • Being post-menopausal. Estrogen regulates bone development and keeps bone health high. As estrogen levels decline during menopause, osteoporotic processes are accelerated.
  • Having a low BMI
  • Not exercising regularly.
  • Some medical conditions (including absorption, hormonal and inflammatory conditions).
  • Long-term steroid use.
  • The long-term use of some medicines.
  • A family history of osteoporosis.
  • Heavy drinking or substance misuse.
  • Having suffered from anorexia or bulimia.

Causes of Osteoporosis

Osteoporosis is primarily caused by a lack of calcium. This may be due to individuals not ingesting sufficient calcium, or it may be due to physiological factors that prevent the calcium from being absorbed and utilized by the body.

Signs and Symptoms of Osteoporosis

There are no outward signs of osteopenia, which is the less severe loss of bone density that can precede osteoporosis. Without diagnostic testing, the first sign that many people have that they have developed osteoporosis is when they fracture a bone. 

Some sufferers from osteoporosis develop a pronounced hump on their back (a kyphosis). This is due to multiple mini fractures of the spinal vertebrae, meaning they're no longer able to hold the head and neck erect.

Testing for osteoporosis is the only way of reliably determining whether you have the condition.

Lab Tests for Osteoporosis

Lab testing aims to try to identify the processes that are contributing to the loss of bone density. Whilst bone density loss can be measured using imaging techniques, lab testing is needed to provide answers to the question of why bone density loss is occurring.

Lab Tests Include:

Osteoporosis FAQs

What to eat to beat osteoporosis?

Generally, nutritionists recommend eating a healthy, balanced diet that's rich in calcium and Vitamin D. Calcium is found in dairy foods, green, leafy vegetables, soy products, nuts, tofu, and oily fish. Vitamin D is normally obtained by getting sufficient sunlight. It's also found in oily fish, eggs (the yolk), and fortified foods.

What exercise should I do to manage my osteoporosis?

Weight-bearing and strength training are the go-to exercises to help maintain bone density. It's also worth exercising to improve balance and flexibility - exercises such as tai chi, yoga, and Pilates can improve balance, making a fall (which could result in a fracture in those with low bone density) less likely.

Can I take medications for osteoporosis?

Some medications can improve bone density and/or prevent further decline. They may include:

  • Bisphosphonates
  • Selective estrogen receptor modulators.
  • Testosterone treatment
  • Hormone Replacement Therapy (HRT).
  • Parathyroid hormone
  • Vitamin D and Calcium supplements

Your primary care provider will be able to discuss drug options with you as part of your osteoporosis care plan.

Can osteoporosis be reversed?

With appropriate lifestyle changes alongside drug therapy, it's often possible to prevent further bone density loss or significantly slow the loss rate.

Unfortunately, it's not usually possible to reverse any osteoporotic changes that have already occurred. Therefore, prompt testing is recommended so that changes can be caught early on before the condition becomes too severe. 

Lab Testing for Osteoporosis FAQs

What's tested at a lab?

A blood sample is required for lab tests that assist in determining potential causes or risk factors for osteoporosis.

Is a lab test all that's needed to diagnose osteoporosis?

No - if your lab test results suggest you have a condition that predisposes you to osteoporosis, we recommend that you get an imaging test (such as a central DXA (Dual Energy X-ray Absorptiometry) to get a bone density score. The bone density score will determine the degree of osteopenia or osteoporosis you're suffering from.

Benefits of Osteoporosis Lab Testing With Ulta Lab Tests

Blood testing is one of the best ways to find out if you have Osteoporosis. Ulta Lab Tests provides a platform for you to order highly accurate and reliable lab tests directly from Quest Diagnostics. Our Osteoporosis lab panels are structured to include a group of tests to detect, monitor, and track your bone health.

By getting tested with Ulta Lab Tests, you can take control of your health and make informed decisions while monitoring the changes in your health.

Our testing is secure and includes confidential results available without insurance or referrals and is very affordable. They're also 100% guaranteed to satisfy. Order your blood tests today, and your results will be provided to you securely and confidentially online in 24 to 48 hours for most tests.

Take charge of your health and track your progress with Ulta Lab Tests!