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Module CC-13 · Version 1.0

Laboratory Assessment of Bone Health and Osteoporosis

How mineral homeostasis testing and bone-turnover markers support, but never replace, the DXA-based diagnosis of osteoporosis, with a guided case on collection timing and serial comparability.

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Who this module is for

Clinical laboratory scientists and trainees working in chemistry and immunoassay, and clinicians who order or interpret bone-health laboratory panels.

Learning objectives

  • Distinguish mineral homeostasis tests from bone-turnover markers
  • Explain formation and resorption markers, biological variation, and timing
  • Recognize that osteoporosis diagnosis and fracture risk are not established by one routine chemistry marker

How completion works

Mark every required section done and answer every knowledge check in those sections correctly. The final save completes the module automatically.

Sources

12 sources

  1. 1. World Health Organization. Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. WHO Technical Report Series 843/921. Geneva: WHO.

    Source note · consensus standard

  2. 2. International Society for Clinical Densitometry. 2023 Official Positions, Adult.

    Source note · accreditation standard

  3. 3. Cosman F, Camacho P, et al. Osteoporosis: Clinical Evaluation. In: Feingold KR, et al., eds. Endotext. South Dartmouth, MA: MDText.com; NCBI Bookshelf NBK279049.

    Source note · peer-reviewed literature

  4. 4. Mayo Clinic Laboratories. Test catalog overviews: Alkaline Phosphatase, Total and Isoenzymes, Serum (ALKP); Bone-Specific Alkaline Phosphatase, Serum (BAP).

    Source note · laboratory reference

  5. 5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD. Kidney Int Suppl. 2017;7(1):1-59.

    Source note · professional society guidance

  6. 6. Vasikaran S, Eastell R, Bruyere O, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int. 2011;22(2):391-420.

    Source note · professional society guidance

  7. 7. Bhattoa HP, et al. Update on the role of bone turnover markers in the diagnosis and management of osteoporosis: a consensus paper from ESCEO, IOF, and IFCC. Osteoporos Int. 2025.

    Source note · professional society guidance

  8. 8. Bauer D, Krege J, Lane N, et al. National Bone Health Alliance Bone Turnover Marker Project: Use of CTX-I and PINP as bone turnover markers, recommendations to standardize sample handling and patient preparation to reduce preanalytical variability. Osteoporos Int. 2018;29(11):2439-2448.

    Source note · consensus standard

  9. 9. Roche Diagnostics. Elecsys Total P1NP and Elecsys beta-CrossLaps/serum method sheets (current package inserts).

    Source note · manufacturer labeling

  10. 10. Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures. PMC9057525.

    Source note · peer-reviewed literature

  11. 11. Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024;109(8):1907-1947.

    Source note · professional society guidance

  12. 12. Clinical and Laboratory Standards Institute. Handling, Transport, Processing, and Storage of Blood Specimens for Routine Laboratory Examinations. 1st ed. CLSI guideline PRE04. Wayne, PA: CLSI; August 2023.

    Source note · consensus standard