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Uncovering the hidden causes of osteoporosis: essential tests every woman should know

By Dr. Susan E. Brown, PhD

Osteoporosis does not happen “just because” — there are always underlying causes. Some of these causes are lifestyle-related, while others stem from undetected health problems, with bone loss as just one symptom.

However, this is not the message most women receive from their conventional doctors. Women with osteoporosis or osteopenia are often immediately prescribed bone drugs without additional testing. In many cases, no further tests are performed beyond the initial DEXA scan, and no effort is made to uncover the root causes of osteoporosis.

If you or your doctor suspect a serious bone health concern, a comprehensive osteoporosis medical work-up is essential. Below are the tests that can help uncover the underlying factors contributing to your bone loss.

Key tests for uncovering the causes of bone loss

Vitamin D 25(OH)D blood test

This test measures your blood level of Vitamin D, allowing you to determine the amount of supplementation needed to reach optimal levels. Adequate Vitamin D is crucial for calcium absorption and overall bone support.

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Ionized calcium test

This simple blood test measures the level of free, metabolically active calcium not bound to proteins in the blood. It indirectly evaluates parathyroid function and can provide insights into your Vitamin D status.

Intact parathyroid hormone blood test (iPTH)

High parathyroid hormone levels are linked to excessive bone loss. Overactive parathyroid glands draw calcium from the bones, so addressing the root causes is critical. A normal parathyroid reading alongside Vitamin D deficiency may also indicate magnesium inadequacy.

24-hour urine calcium excretion test

This test measures how much calcium is excreted in your urine over 24 hours. Excessive urinary calcium excretion is a common cause of bone loss. To ensure accurate results, stop high-dose calcium supplements (over 100 mg) one week before the test.

Thyroid hormone function test (TSH)

Thyroid hormone levels that are too high or too low can lead to bone loss. This test screens for underactive or overactive thyroid conditions, both of which may contribute to osteoporosis.

Free cortisol test (blood or saliva)

Cortisol, often referred to as the “stress hormone,” can damage bone when levels are abnormally high. Elevated cortisol is a significant risk factor for osteoporosis and low-trauma fractures.

DHEA test (blood or saliva)

DHEA, a hormone produced by the adrenal glands and ovaries, helps neutralize cortisol and supports bone density. Low DHEA levels are linked to osteoporosis, and stress reduction activities like yoga can help maintain youthful DHEA levels.

C-reactive protein test (high-sensitivity)

This test detects inflammation, which contributes to both heart disease and osteoporosis. High C-reactive protein levels indicate unwanted inflammation that may impact bone health.

Homocysteine test (plasma or serum)

High homocysteine levels, resulting from inadequate B vitamins, can damage collagen and increase the risk of fractures. This test identifies a critical risk factor for osteoporosis.

Celiac disease & gluten sensitivity test

Celiac disease or gluten sensitivity can cause gut inflammation and nutrient malabsorption, leading to bone loss. Testing for these conditions can uncover deficiencies in Vitamins A, K and D, which are vital for bone health.

Sex hormone tests

  • Postmenopausal women: Estrogen and progesterone naturally decline during menopause, impacting bone health. While testing isn’t typically necessary, it may be helpful for women on hormone replacement therapy.
  • Premenopausal women: Low estrogen or progesterone levels can impair peak bone mass development. Hormone testing is especially important for women with irregular or missed periods.
  • Men: Low testosterone is a common cause of osteoporosis in men. Testing for testosterone, and occasionally estrogen, is critical in diagnosing male bone health issues.

Take charge of your bone health

Osteoporosis is not an inevitable part of aging or a condition without cause. It’s often a symptom of deeper health issues or lifestyle factors that can and should be addressed. Unfortunately, many women are prescribed bone drugs without the necessary testing to uncover the root causes of their bone loss.

comprehensive osteoporosis medical work-up is the key to understanding your bone health. By identifying factors like Vitamin D levels, calcium excretion, hormone imbalances and inflammation, you can create a personalized plan to rebuild and protect your bones naturally.

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Your bone health is in your hands. By understanding the “why” behind your bone loss, you can take the first step toward lasting solutions. Don’t settle for a one-size-fits-all approach — investigate, uncover and empower yourself to take control of your bone health journey.

Last Updated: January 1, 2025
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