Osteoporosis
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Osteoporosis
Initial laboratory tests
- FBC
- CRP
- Serum creatinine with clearance estimation
- Serum calcium
- Serum phosphate
- Alkaline phosphatase
- 25-hydroxyvitamin D (reimbursed: looking for osteomalacia)
- Serum protein electrophoresis
- Serum albuminif needednon-French guidelineTo interpret serum calcium (albumin-corrected calcium), notably before deciding to measure PTH [2].
- TSHif neededLooking for hyperthyroidism or thyroid hormone overdose, a secondary cause of osteoporosis [3]; thyroid tests as routine for the NOGG [2].
- PTH (if corrected serum calcium ≥ 2.6 mmol/L on two occasions)if needednon-French guidelinePersistent hypercalcaemia: looking for primary hyperparathyroidism [2]; procedure 0983 is reimbursed for the diagnosis of parathyroid adenoma (see the page “Hypercalcaemia”).
- Total testosterone (man)if neededOsteoporotic man: looking for hypogonadism [2,3].
- Transferrin saturationif neededLooking for haemochromatosis, a secondary cause cited by the French College of Rheumatology [3].
- 24-hour urinary free cortisolif neededSuspected hypercortisolism (suggestive clinical signs) [2,3].
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)if neededSuspected malabsorption, notably coeliac disease, sometimes subclinical [3]; see the page “Coeliac disease”.
- Total IgAif neededSuspected malabsorption, notably coeliac disease, sometimes subclinical [3]; see the page “Coeliac disease”.
- ASTif needednon-French guidelineRoutine tests in the United Kingdom (transaminases, NOGG 2024) [2] and in the United States (liver function tests, Bone Health and Osteoporosis Foundation, 2022), where chronic liver diseases, including primary biliary cholangitis, are among the causes of secondary osteoporosis [4]; in Germany, the DVO (2023) measures GGT with alkaline phosphatase [5]. The list from the French College of Rheumatology does not cite them [3].
- ALTif needednon-French guidelineRoutine tests in the United Kingdom (transaminases, NOGG 2024) [2] and in the United States (liver function tests, Bone Health and Osteoporosis Foundation, 2022), where chronic liver diseases, including primary biliary cholangitis, are among the causes of secondary osteoporosis [4]; in Germany, the DVO (2023) measures GGT with alkaline phosphatase [5]. The list from the French College of Rheumatology does not cite them [3].
- GGTif needednon-French guidelineRoutine tests in the United Kingdom (transaminases, NOGG 2024) [2] and in the United States (liver function tests, Bone Health and Osteoporosis Foundation, 2022), where chronic liver diseases, including primary biliary cholangitis, are among the causes of secondary osteoporosis [4]; in Germany, the DVO (2023) measures GGT with alkaline phosphatase [5]. The list from the French College of Rheumatology does not cite them [3].
- Urinary calciumif needednon-French guidelineBaseline tests in the United States (Bone Health and Osteoporosis Foundation, 2022), which counts hypercalciuria among the causes of osteoporosis [4]; in the United Kingdom, urinary calcium is requested when indicated (NOGG 2024) [2]. The list from the French College of Rheumatology does not cite it [3].
- 24-hour urine creatinineif needednon-French guidelineBaseline tests in the United States (Bone Health and Osteoporosis Foundation, 2022), which counts hypercalciuria among the causes of osteoporosis [4]; in the United Kingdom, urinary calcium is requested when indicated (NOGG 2024) [2]. The list from the French College of Rheumatology does not cite it [3].
Do not order
Follow-up on treatment (depending on the drug)
Laboratory tests
- Serum creatinine with eGFR (if zoledronic acid, before each infusion)if neededZoledronic acid: creatinine clearance (Cockcroft–Gault, actual weight) to be calculated before each administration; contraindicated if < 35 mL/min [12].
- Serum calcium (if denosumab, before each injection)if neededDenosumab: calcium monitoring recommended before each administration, and within 2 weeks of the first dose in patients predisposed to hypocalcaemia (notably severe renal impairment) [13].
Do not order
- Bone turnover markers as a matter of course on treatment: clinical usefulness uncertain according to the HAS [9].
Sources (17)
- Ostéoporose Des os fragilisés à risque de fracture
- Gregson CL, Armstrong DJ, Avgerinou C, et al. The 2024 UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2025;20(1):119. doi:10.1007/s11657-025-01588-3.
- Ostéopathies fragilisantes (Collège français des enseignants de rhumatologie, item Ostéoporose, rubriques 4.3.2 et 6)
- LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022;33(10):2049-2102 (guide de la Bone Health and Osteoporosis Foundation, États-Unis).
- Dachverband Osteologie (DVO, Allemagne). Kurzfassung der DVO-Leitlinie 2023 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern, version 2.2 (avril 2024).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 du 2 juin 2026 : actes 0983 (PTH), 1139 (25-OH-vitamine D) ; absence d'acte actif pour la VS.
- Briot K, Roux C, Thomas T, et al. 2018 update of French recommendations on the management of postmenopausal osteoporosis. Joint Bone Spine. 2018;85(5):519-530. doi:10.1016/j.jbspin.2018.02.009.
- Haute Autorité de santé. Utilité clinique du dosage de la vitamine D. Rapport d'évaluation, texte court, octobre 2013.
- Prévention, diagnostic et traitement de l’ostéoporose
- Haute Autorité de santé. Les médicaments de l'ostéoporose. Fiche de bon usage du médicament, mise à jour janvier 2023.
- Agence européenne des médicaments. Fosavance (alendronate/colécalciférol) : résumé des caractéristiques du produit, rubriques 4.2 et 4.4.
- Agence européenne des médicaments. Aclasta (acide zolédronique) : résumé des caractéristiques du produit, rubriques 4.3 et 4.4.
- Agence européenne des médicaments. Prolia (dénosumab) : résumé des caractéristiques du produit, rubrique 4.4.
- Centre belge d'information pharmacothérapeutique (CBIP). Fiche de transparence « Ostéoporose », version en ligne avec mises à jour (recherches jusqu'au 15 mars 2015).
- Conseil scientifique du domaine de la santé (Luxembourg), groupe de travail Laboratoire. Ostéoporose (texte court), 21 juillet 2010.
- Harris K, Zagar CA, Lawrence KV. Osteoporosis: Common Questions and Answers. Am Fam Physician. 2023;107(3):238-246.
- Morin SN, Feldman S, Funnell L, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ. 2023;195(39):E1333-E1348. doi:10.1503/cmaj.221647.