*alkaline phosphatase --If the alkaline phosphatase level is elevated, fractionation of this enzyme is helpful, as isoenzymes are secreted by several tissues, including bone, liver, kidney, and intestine.
*Urine hydroxyproline and hydroxylysine-- There is an elevated urinary excretion of hydroxyproline and hydroxylysine; both are degradation products of bone's organic matrix. Patients with Paget's disease can excrete up to 20 times more hydroxyproline than normal persons.
*pyridinoline cross-link assays-- important components to measure bone resorption
*calcium excretion in the urine -- Calcium excretion remains an important method for determining the rate of bone loss, and the 24-hour urine collection is a means for determining calcium and phosphorus balance. If calcium excretion in the urine is increased, treatment may be indicated to augment total-body calcium retention.
*Phosphorus excretion -- indicates the effects of PTH on the kidney and is usually elevated when the PTH activity is high.
*carboxyglutamic acid in the serum or urine/ osteocalcin -- low-molecular-weight protein synthesized only by osteoblasts and secreted directly into the circulation. Measurement of the protein in serum or urine is indicative of bone turnover
*PTH, and the vitamin D metabolites -- These more expensive tests should be reserved for those patients in whom a specific abnormality is suspecte
*serum protein electrophoresis -- to rule out an occult lymphoproliferative malignancy such as myeloma. This condition is frequently a cause of spinal pain and bone loss and has been shown to mimic osteoporosis radiographically.
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