Differential Diagnosis of Metabolic Bone Diseases

- See: Transient Osteoporosis:


  Disorder       Serum Ca     Serum Phos     Serum AP     Urine
Osteoporosis     Normal       Normal         Normal       Normal Ca
Osteomalacia       "           "               "         Low     Ca
HyperParaThy     Hi- Norm     Low -Norm         "       High   Ca
HypoParaThy     Low         High
Renal OsteoD     Low         High           High         - - - -
Paget's dz       Normal       Normal         High         Hydroxyproline
Myeloma           "           "             "         Protein
Rickets
    Vit-D def     Normal       Low
    Vit-D dep     Low        
Low
    Vit-D res     Normal       Very Low

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                  Osteomalacia         Osteoporosis         HyperPara       Renal
            Vit D def   HypoPhos   Idiopathic   2ndary
Serum Ca     Low   Normal         Normal       Normal           High           Norm/Low
Serum P     Low   Very Low   Normal       Normal   Low         High
Alk Phos     High     High       Normal       Normal       Norm/High     High
Urine Ca     Low         Normal     Normal     Norm/High   Norm/High   Very low
Osteocalcin Norm/Incr   High       Normal       High     High         High
HydroxyPro   Norm/Incr   High       Normal       High     High         High
X-rays       Decr Density and         Decr Density       Norm/Osteitis Fibrosa
              Looser's Zones
Biopsy       Incr Osteoid Volume     Thin Cortx & Trabec   Norm/Osteitis Fibrosa
                                      and bone loss