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Advanced - Bone Profile

Bone

8 parameters

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Report in 12Hrs

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At Home

nofastingrequire

No Fasting Required

Details

Basic metabolic bone panel (Ca, P, ALP).

₹1,499₹2,150

30% OFF

Parameters

  • List of Tests
    • Calcium
    • Alkaline Phosphatase
    • Magnesium
    • Phosphorous
    • PTH - Intact
    • 25 OH Vitamin D
    • Vitamin B12
    • Zinc (Serum)

Advanced - Bone Profile

  • Why is it done?
    • Comprehensive assessment of bone health and mineral metabolism to evaluate bone density, strength, and remodeling processes
    • Diagnosis and monitoring of osteoporosis, osteopenia, and other metabolic bone diseases including rickets and Paget's disease
    • Evaluation of parathyroid function and vitamin D status to assess calcium and phosphate homeostasis
    • Investigation of patients with chronic kidney disease, hypercalcemia, hypocalcemia, or unexplained bone pain
    • Assessment of nutritional status including deficiencies in vitamin B12 and zinc which impact bone formation and immune function
    • Screening in elderly patients, postmenopausal women, patients on long-term corticosteroids, and those with family history of osteoporosis
    • Monitoring effectiveness of therapies for bone disease and assessing risk of fractures and complications
    • Individual tests work together to provide complete picture: Calcium and Phosphorous are primary structural minerals; PTH and Vitamin D regulate their balance; Alkaline Phosphatase indicates bone turnover; Magnesium and Zinc support bone formation; Vitamin B12 influences bone metabolism
  • Normal Range
    • Calcium: 8.5-10.2 mg/dL (2.12-2.55 mmol/L) - Total serum calcium; normal reflects proper parathyroid and kidney function
    • Alkaline Phosphatase (ALP): 30-120 IU/L (0.5-2.0 µkat/L) - Reflects bone formation activity; elevated in growing children and during bone remodeling
    • Magnesium: 1.7-2.2 mg/dL (0.70-0.90 mmol/L) - Essential cofactor in bone mineralization and calcium regulation
    • Phosphorous: 2.5-4.5 mg/dL (0.80-1.45 mmol/L) - Critical mineral in bone structure and energy metabolism
    • PTH - Intact (Parathyroid Hormone): 15-65 pg/mL (1.6-6.9 pmol/L) - Controls calcium and phosphate homeostasis; intact molecule reflects active hormone
    • 25 OH Vitamin D (Calcidiol): 30-100 ng/mL (75-250 nmol/L) - Optimal levels; <20 ng/mL indicates deficiency; 20-29 ng/mL is insufficient
    • Vitamin B12 (Cobalamin): 200-900 pg/mL (148-664 pmol/L) - Supports bone marrow function and neurologic health; low levels affect bone metabolism
    • Zinc (Serum): 60-120 µg/dL (9.2-18.5 µmol/L) - Essential for bone formation, mineralization, and immune function; critical cofactor in bone metabolism
  • Interpretation
    • Calcium - Elevated (>10.2 mg/dL): Hyperparathyroidism, vitamin D intoxication, bone metastases, hyperthyroidism, immobilization; Decreased (<8.5 mg/dL): Hypoparathyroidism, vitamin D deficiency, chronic kidney disease, hypoalbuminemia, vitamin D resistant rickets
    • Alkaline Phosphatase - Elevated: Active bone formation/remodeling, Paget's disease, rickets, liver disease, bone metastases, fracture healing; Decreased: Hypophosphatasia, hypoparathyroidism; NOTE: Bone-specific ALP (BSAP) is more specific for bone turnover
    • Magnesium - Elevated (>2.2 mg/dL): Rare; seen in severe renal failure or excessive supplementation; Decreased (<1.7 mg/dL): Malabsorption, chronic diarrhea, diuretic use, proton pump inhibitors, alcohol use, reduces PTH secretion and action
    • Phosphorous - Elevated (>4.5 mg/dL): Renal failure, hypoparathyroidism, vitamin D intoxication, hemolysis; Decreased (<2.5 mg/dL): Hyperparathyroidism, vitamin D deficiency rickets, malabsorption, renal wasting, refeeding syndrome
    • PTH - Elevated: Primary/tertiary hyperparathyroidism, secondary hyperparathyroidism (chronic kidney disease), vitamin D deficiency; Decreased: Primary hypoparathyroidism, vitamin D intoxication, hypercalcemia; PTH-calcium relationship is diagnostically important
    • 25 OH Vitamin D - <20 ng/mL: Deficiency with risk of rickets, osteomalacia, impaired calcium absorption; 20-29 ng/mL: Insufficiency with suboptimal bone health; >100 ng/mL: Excessive supplementation or toxicity (rare but possible); affects intestinal calcium absorption and bone mineralization
    • Vitamin B12 - Low (<200 pg/mL): Pernicious anemia, intrinsic factor deficiency, vegan diet, metformin/PPI use, impaired bone marrow function and bone metabolism; Elevated (>900 pg/mL): Rarely clinically significant, may indicate B12 injection therapy or myeloproliferative disorders
    • Zinc - Low (<60 µg/dL): Malnutrition, malabsorption, chronic diarrhea, chronic liver disease, impaired bone formation and immune dysfunction; Elevated (>120 µg/dL): Rare; usually from supplementation; minimal clinical significance; NOTE: Zinc levels can fluctuate with time of day and stress
  • Associated Organs
    • Calcium: Primary role in bone structure; regulated by kidneys (reabsorption) and parathyroid glands (PTH production); intestines (absorption); complications include nephrolithiasis, cardiac arrhythmias, neurologic dysfunction
    • Alkaline Phosphatase: Produced by osteoblasts in bone; elevated in liver disease and biliary obstruction; bone-specific ALP is more specific for skeletal remodeling; indicates active bone formation and turnover
    • Magnesium: Cofactor in bone mineralization; regulated by kidneys; essential for normal PTH secretion and action; deficiency impairs calcium regulation and increases osteoporosis risk
    • Phosphorous: Primary structural mineral in bone (hydroxyapatite); regulated by kidneys and PTH; critical for ATP energy production; kidney disease leads to hyperphosphatemia and secondary hyperparathyroidism
    • PTH (Parathyroid Glands): Primary regulator of calcium and phosphate homeostasis; stimulates kidney activation of vitamin D; increases bone resorption; elevated PTH in chronic kidney disease causes secondary hyperparathyroidism and bone disease
    • Vitamin D (Kidneys and Skin): Activated in kidneys to 1,25-dihydroxyvitamin D; produced by skin upon sun exposure; essential for intestinal calcium absorption; deficiency causes impaired mineralization and osteomalacia
    • Vitamin B12 (Gastrointestinal and Hematologic Systems): Absorbed in terminal ileum requiring intrinsic factor; essential for bone marrow function and DNA synthesis; deficiency impairs osteoblast function and increases fracture risk
    • Zinc (GI Tract, Liver, Immune System): Absorbed in small intestine; stored in bone and involved in osteoblast function; essential for collagen synthesis and bone matrix formation; deficiency impairs fracture healing and immune response
  • Follow-up Tests
    • Calcium abnormalities: Ionized calcium (more specific than total), albumin level (affects interpretation), 24-hour urine calcium, parathyroid imaging if hyperparathyroidism suspected
    • Alkaline Phosphatase elevation: Bone-specific alkaline phosphatase (BSAP), P1NP (procollagen type 1 N-terminal propeptide), liver function tests, GGT to differentiate bone vs liver origin
    • Magnesium abnormalities: 24-hour urine magnesium, assess for malabsorption, evaluate medications (diuretics, PPIs), assess for chronic diarrhea
    • Phosphorous abnormalities: PTH-phosphate relationship evaluation, renal function tests (creatinine, eGFR), 24-hour urine phosphate, imaging for bone disease
    • PTH abnormalities: 1,25-dihydroxyvitamin D (active form), imaging of parathyroid glands (ultrasound/sestamibi scan), 24-hour urine calcium, FibroTest or bone biopsy for fibrosis
    • Vitamin D abnormalities: 1,25-dihydroxyvitamin D, parathyroid imaging if PTH elevated, bone mineral density (DEXA scan) if deficiency confirmed, monitor annually
    • Vitamin B12 abnormalities: Methylmalonic acid (MMA), homocysteine levels, intrinsic factor and parietal cell antibodies (pernicious anemia), peripheral blood smear, assess for neurologic manifestations
    • Zinc abnormalities: 24-hour urine zinc, assess for malabsorption (tissue transglutaminase for celiac), albumin level (carrier protein), prealbumin for nutritional status
    • General bone health: Bone mineral density (DEXA scan), CTX or P1NP (bone turnover markers), CT or MRI if malignancy or metastases suspected, fracture risk assessment (FRAX)
    • Comprehensive renal function: Creatinine, BUN, eGFR, 24-hour urine protein; crucial for interpreting PTH and mineral status as kidney disease affects all parameters
    • Monitoring frequency: Annual for stable patients with mild abnormalities; every 6 months for moderate deficiencies; every 3-6 months during active treatment; more frequently if hospitalized or on dialysis
  • Fasting Required?
    • Fasting: NO - Fasting is NOT required for the Advanced Bone Profile test package; all eight individual tests can be performed on non-fasting samples
    • Medications to avoid: No specific medications need to be held before testing; however, results interpretation should consider ongoing medications that affect bone metabolism
    • Medications affecting results: Bisphosphonates, vitamin D supplementation, PTH analogs, calcium supplements, thiazide diuretics, loop diuretics, corticosteroids, anticonvulsants, vitamin B12 injections should be noted and reported to laboratory
    • Dietary considerations: Maintain normal calcium, magnesium, and phosphorus intake; avoid extreme fasting or fasting longer than typical daily schedule as may affect mineral levels; zinc and vitamin B12 absorption best with normal food intake
    • Timing considerations: Vitamin D and PTH have circadian variation; ideally draw in morning (8-10 AM) for consistency; alkaline phosphatase and minerals relatively stable throughout day but morning preferred
    • Specimen collection: Single venipuncture into standard serum separator tube (SST) or specified tube per laboratory protocol; minimal hemolysis required as calcium/minerals may be affected
    • Patient preparation: No special preparation needed; patient may eat and drink normally; continue regular medications unless specifically instructed otherwise by ordering physician
    • Activity/stress: Strenuous exercise immediately before testing may transiently affect some markers; light normal activity is acceptable; physical activity should be noted if unusually strenuous

How our test process works!

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