The test should be done on a patient's customary calcium intake. Protein electrophoresis should be done whenever a patient presents with new fractures. Both serum and urine tests should be done some patients with myeloma have abnormalities in only one. Corticosteroid excess that causes osteoporosis can usually be detected clinically by Cushingoid features. A urine cortisol can be helpful in puzzling cases.
Gonadal hormones are very important causes of osteoporosis.
In females who are postmenopausal, it is not helpful to measure levels of estrogens or gonadotropins. In males, however, testosterone levels should be measured because there is much greater variability in the prevalence of hypogonadism. Also, men may have low testosterone without other clinical symptoms. If testosterone is low, then further work-up is needed. Vitamin D and parathyroid hormone levels are expensive tests.