As well as a DXA scan, the following additional tests should be carried out routinely to exclude secondary causes of osteoporosis:

  • History and physical examination
  • Blood cell count, sedimentation rate or C-reactive protein, serum calcium, albumin, creatinine, phosphate, alkaline phosphatase, liver transaminases
  • Thyroid function test

The GP should also be aware that the following diseases and drugs are associated with increase fracture risk (adapted from SIGN 142). 


  • Diabetes
  • Inflammatory rheumatic diseases
  • Inflammatory bowel disease and malabsorption
  • Epilepsy in institutionalised patients 
  • Primary hyperparathyroidism and endocrine diseases 
  • Chronic liver disease
  • Neurological diseases (including Alzheimer's disease, Parkinson's disease, multiple sclerosis, stroke)
  • Moderate to severe chronic kidney disease
  • Asthma 


  • Long-term antidepressants
  • Anti-epileptics
  • Aromatase inhibitors
  • Long-term depot medroxyprogesterone acetate (DMPA)
  • Gonadotropin-releasing hormone (GnRH) agonists (in men with prostate cancer)
  • Proton pump inhibitors (PPIs)
  • Oral glucocorticoids
  • Thiazolidinediones/glitazones (TZDs)

More information for you and your patients

Download our leaflets, posters and factsheets to share with your patients. Including factsheets on 'thyroid disease and osteoporosis', 'hyperparathyroidism and osteoporosis' and 'bone markers (blood and urine tests) and osteoporosis'. 

Free publications to order and download

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