Bone health BASIC

What are the bones

Bone is a metabolically active organ where there's a continual cycle of old bone breakdown and new bone tissue formation. The whole process is controlled by hormones and growth factors [1,2]. Bones play many important roles in the human body. Changes in bone metabolism can happen at various life stages and might be linked to other conditions, treatments, as well as the natural ageing process. The most widely recognised metabolic bone disorder is osteoporosis [3].

The test should be conducted in cases of dull, vague back pain, particularly between the shoulder blades and in the lumbar region, as well as reduced or restricted mobility, bone pain during everyday activities such as sitting or standing, fatigue, weakness, malaise, and joint and muscle pain. This package is suitable for those who want to check the health of their bones.

What the test of osteoporosis includes

Bone health BASIC includes basic parameters that provide information about bone metabolism. In addition to determining the levels of calcium and phosphorus, the test includes total level of ALP (alkaline phosphatase), hormones such as osteocalcin and vitamin D, and marker CRP (C-reactive protein) and bone markers Beta-CrossLaps and P1NP. The test is complemented by a complete blood count with a differential count.

Calcium

Calcium plays crucial roles in the body. It's responsible for the hardness and strength of human bones, contributes to the proper function of the nervous and muscular systems, and is essential for heart function and blood clotting. The largest reserve of calcium, approximately 99%, is stored in the bones and teeth. 

Phosphorus

Phosphorus, in its inorganic form bound as calcium phosphate and hydroxyapatite, constitutes a component of bones and teeth. In its organic form, phosphorus is crucial for the proper functioning of muscles, the nervous system, energy production, and the maintenance of the internal environment of human body. 

ALP 

ALP, alkaline phosphatase, is an enzyme that influences the metabolism of high-energy phosphate bonds and assists in the transport of inorganic phosphate across the cell membrane. It is mainly found in bone and liver cells.

Blood counts

Blood counts and differential leukocyte counts can help rule out infection and immune system disorders, detect anaemia which can indicate impaired oxygen supply to tissues, and raise suspicion of a clotting disorder or risk of blood clots.

CRP 

CRP is one of the acute phase reactants and is a component of the body's immune defense system. As a useful indicator with good dynamics, it is especially helpful in tracking infections/inflammation.

Vitamin D 

Vitamin D is a crucial fat-soluble vitamin that serves vital functions in the human body. It's essential for the proper growth and development of bones and teeth, as it stimulates bone formation by activating osteoblasts to synthesise collagen and promotes mineralisation. Deficiency in vitamin D leads to a reduction in calcium content in bone tissue.

Osteokalcin

Osteocalcin serves as an indicator of bone remodelling. It's produced in osteoblasts and chondrocytes, and it binds mineral components such as calcium and hydroxyapatite in organic bone matter.

We do not recommend entry of patients/clients with clinical signs of disease (temperature, cough, signs of respiratory tract infection, etc.) to undergo this test.
We recommend hand disinfection prior to entry to the clinics/collection points.

It is advised to fast for a minimum of 8 hours by refraining from eating or drinking anything expect water. Faiing to fast before the test may affect result quality. If you are currently on medications, consult your healtcare provider to determine whether you should continue taking them prior to the test.

PREPARATION FOR BLOOD COLLECTION
The recommended time to collect blood is between 7 a.m. and 9 a.m., to obtain comparable results from different blood draws. To assess the numerical test result, so-called reference intervals are used, which are based on morning fasting collections and are used for population comparison. This time interval is also recommended in light of the biological cycles that naturally take place in the body.

GENERAL PRE-SAMPLING INSTRUCTIONS
• It is necessary to come to the testing site earlier, so that you can rest in the waiting room for approximately 20 minutes to have a relatively relaxed body and mind.
• It is not advisable to draw blood before collection.
• It is necessary to arrive on an empty stomach for the collection itself, in the case of collections at a later time in the day, at least three hours on an empty stomach. At home, it is desirable to drink a sufficient amount of pure water (at least up to half a liter) - this is important for a successful blood collection. Mineral water, juice, coffee and tea are not recommended.
Herbs included in tea may contain substances affecting the blood count. Coffee and black tea increase gastric acid production and release insulin from the pancreas, thereby affecting glucose metabolism. Since everything in the body is interrelated, they can impact other tests. Another extreme is when your body is running out of fluids. In this case, the number of red blood cells, the level of protein and lipids bound to the protein increase and the level of urea in the blood can also increase. It is therefore advisable to drink pure water when you wake up.


Generally, it is recommended to:
• around 6 p.m. eat only light meals, do not eat fatty food (cheese, butter, cream, meat, smoked meat, bacon) and sweet meals,
• fast for 10-12 hours (Attention: it is not advisable to starve for more than 16 hours!), in the case of later collection (after 9:30 a.m.), a lighter breakfast is allowed, no later than 3 hours before collection,
• drink non-alcoholic beverages and drinks without sugar in the usual quantity, in the case of adult clients 24 hours before blood collection (Alcohol in the blood changes lipid levels, the level of glucose is reduced, uric acid levels increase and liver enzymes are released into the blood),
• take only prescribed medicines in the evening,
• avoid increased physical activity, and strength and endurance exercise the day before blood collection (Lipid, glucose, some enzyme levels in the blood and other parameters may change during physical activity. The recovery of normal values to maintain the accuracy of laboratory results may take a longer time, depending on the duration of the exercise, your physical fitness in general and other factors. We recommend maintaining normal daily physical activity such as light stretching, short cycling to work, gardening, etc.),
• avoid psychological stress, which raises blood glucose levels and causes the release of stress hormones in particular,
• avoid smoking for at least 6 hours prior to blood collection because it increases the level of carbonylhemoglobin produced by the reaction of the blood dye with carbon monoxide and alters the permeability and elasticity of the vessels, affecting the ratios of blood analytes,
• do not chew gum for at least 6 hours before blood collection, as this may affect glucose and enzyme levels,
• do not undergo stressful diagnostic or therapeutic interventions for at least 24 hours prior to blood collection.
If any of the tests you have selected require special preparation, you will be informed of the fact by email with the order and blood collection instructions attached. These specific instructions have priority over the general recommendations for preparation.


MEDICINES
It is recommended to have blood collected before the planned doses of medicines. If it is not possible to take the medicine later, you should inform the nurse during blood collection and specify what medication you have taken.
Take the medicines prescribed by your doctor in the morning or bring them with you to take them after blood collection (thyroid medicines, antihypertensive medicines, blood thinners, contraceptives, etc.) In the case of later collection (after 9:30 a.m.), you can take the prescribed medication in the morning.
Do not take iron, vitamin, nutritional supplements or other supplements, including homeopathics, for at least three (3) days prior to blood collection.


SPECIFIC SITUATIONS
In order to obtain the appropriate answers to your questions with regard to the laboratory tests, it is important to accurately notify the nurse at the healthcare provider about the following facts prior to your blood test:
• regularly used medicines and supplements (ideally come with a written list to the blood collection site),
• infectious diseases you suffer from (e.g., HIV, hepatitis, mononucleosis...),
• contact with an infected person or presence in an infectious environment,
• if you have received an infusion within the last 5 days, specify into which limb,
• intramuscular injections within 3 days prior to the blood collection date,
• long-term immobilisation, lost ability to move,
• activities at higher altitudes,
• allergy to common band-aids,
• if you feel unwell when looking at blood or needles, please also notify our blood collection staff of the fact.


OTHER FACTORS
Please note that prolonged use of medication or other important factors may affect the values measured by the tests you have selected. For more information, please see the description of the specific test. To obtain objective test results, take the time to properly prepare for your blood collection.

[1]Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357:266.

[2]Thomson CA, Aragaki AK, Prentice RL, et al. Long-Term Effect of Randomization to Calcium and Vitamin D Supplementation on Health in Older Women : Postintervention Follow-up of a Randomized Clinical Trial. Ann Intern Med 2024; 177:428.

[3]Payer J.,Killinger Z., Jackuliak P. et al. Osteoporóza. Štandardný diagnostický a terapeutický postup. MZ SR 15.11.2023