Recommended biochemical tests for patients being assessed for osteoporosis as per the 2010 OC Guidelines: serum calcium corrected for albumin or ionized calcium, complete blood count (CBC), creatinine or eGFR, alkaline phosphatase, thyroid stimulating hormone (TSH). For patients with vertebral fractures, a serum protein electrophoresis is also recommended. Vitamin D (25-hydroxy vitamin D) should be measured after 3-4 months of adequate supplementation and should not be repeated if optimal level ≥ 75 nmol/L is achieved.

The IOF Best Practice Framework indicates that patients with any fragility fracture should be assessed for the presence of spine fractures. This requires a lateral view of the thoracic and lumbar spine, typically by conventional x-rays or, where available, by Vertebral Fracture Assessment (VFA) by DXA. If the initial presenting fracture is a vertebral fracture, it is important to ensure that the entire spine is imaged (e.g. if a T10 fracture is identified on a lateral chest x-ray, then a lateral view of the lumbar spine is also indicated).

Adequate vitamin D supplementation is important, not only for bone health, but also because it has been proven to reduce the risk of falls and fractures. Osteoporosis Canada recommends vitamin D supplementation of 800-2000 IU/day for adults ≥ 50 years of age.