Bone health PLUS

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 PLUS includes

Bone health PLUS 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) and isoenzymes, ALT and GGT (liver transaminases), albumin, total level of serum proteins, creatinine, glomerular filtration rate (GFR), calcium and phosphorus in urine, and calculated parameters such as fractional excretions for calcium and phosphorus, 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.

Osteocalcin

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.

Urinary calcium

Urinary calcium levels provide information about calcium and vitamin D intake, parathyroid function, chronic kidney disease, osteolysis, or the administration of certain medications.

Urinary phosphorus 

Urinary phosphorus (its levels) depend on dietary intake, the balance between tissue synthesis and breakdown, renal function, and various regulatory mechanisms such as the action of vitamin D, parathyroid hormone, calcitonin, fibroblast growth factor (FG), and others.

Fractional excretion

FE, or fractional excretion, indicates the proportion of a substance excreted in the final urine output compared to the total amount filtered. It's used to evaluate tubular function without requiring urine collection.

Creatinine

Creatinine is a waste product, and its blood levels serve as a reliable indicator of kidney function. It's excreted into the urine at a relatively constant rate. Testing creatinine levels enables the detection of kidney function disorders.

Albumin

Albumin, as the primary protein in blood plasma, plays several crucial roles. It's involved in transporting minerals and other substances, maintaining oncotic plasma pressure, and binding toxic heavy metals as well as a variety of drugs.

ALT

ALT is an enzyme present mainly in liver cells. It also plays a role in nitrogen and glucose metabolism, as well as in the formation and breakdown of amino acids.

GGT

GGT is an enzyme that is highly sensitive to changes in liver function and bile duct damage.

Glomerular filtration rate

The estimated glomerular filtration rate (CKD-EPI eGFR) is one of the key indicators of kidney function. The CKD-EPI equation has been recommended by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force since 2021.

P1NP

P1NP, or type 1 procollagen, is synthesised by fibroblasts and osteoblasts and serves as a specific indicator of type 1 collagen deposition in bone, making it a reliable marker of bone formation.

Beta-CrossLaps

Beta-CrossLaps is a fragment of type I collagen used to evaluate bone resorption and monitor osteoclast activity.

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.

PREPARATION FOR URINALYSIS

If you have chosen a chemical analysis of urine and urine sediment based on the first morning urine sample, do not forget to obtain a collection tube, either at the pharmacy or at any of our sampling points. If urine culture is tested, this tube must be sterile.
 

INSTRUCTIONS TO FOLLOW
It is recommended to follow the standard drinking regime prior to urine collection, to avoid coffee and alcohol (in the case of adult clients) that are diuretic and could dilute the urine as a result of its increased production. 24 hours prior to urine collection, sexual intercourse is not appropriate because the number of cellular particles and protein in the urine will increase.
Girls and women undergo this test outside their menstrual cycle, it is not recommended to collect urine samples 3 days before or 3 days after the cycle, when red blood cells that are not produced in the urinary tract may be present. The results can be evaluated as false positives.
 

HYGIENE
Immediately before the urine collection, it is important to thoroughly clean the genitourinary tract so that urine is not contaminated with mucus, bacteria or soap. When urinating, women and girls will separate their labia and wash their external genital organs with lukewarm water. Men and boys will pull back their foreskin and wash their penis. Your hands must be clean when doing so.
 

PROCEDURE

For the examination it is necessary to bring morning urine - bring a 10 ml sample of the entire volume of morning urine, not the middle stream. The entire volume of morning urine should be captured in a collection container and then 10 mL should be collected from it into a collection tube. Close the tube tightly and rinse with water. Be careful of the cap of the tube. It must not be picked up with the inside by the hands or placed on the sink or bath. The cap of the tube must only be held on the outer circumference to avoid contamination of the collected urine by bacteria present on the hand or furniture.
 

STORAGE AND TRANSPORT
The sample should be delivered for analysis within 4 hours after its collection and should be maintained at 4-8 °C to avoid the decomposition of cellular elements in the urine or the bacterial proliferation at higher temperatures. Biochemical quantitative urine assay A sample of spontaneous urination is collected for examination. A urine collection tube should be prepared in the evening before the test date. If you do not have an original urine collection tube, a 3dcl jar is sufficient. The jar must be clean, rinsed with boiling water and left to dry. Collect all of the urine in the jar after performing morning genitourinary tract hygiene, then pour approximately 10 ml of urine into the collection tube. You will obtain a mixed representative sample needed to determine creatinine, total protein, albumin levels or urine electrophoresis.
One common, clean urine collection tube, usually with a yellow cap, is sufficient for the chemical analysis of urine and urinary sediment. For culture testing, urine should be collected in a sterile tube, usually with a red cap. The use of empty bottles and other household urine collection containers is not appropriate due to the presence of bacteria and other components. One common, clean urine collection tube, usually with a yellow cap, is required for a quantitative biochemical assay. Proper preparation prior to the urine collection is a must for a correct result. A correct result is one of the conditions to reach the correct diagnosis.
 

SPECIFIC SITUATIONS
In order to obtain relevant answers to your questions through laboratory tests, it is important to accurately inform about the following facts before your blood test:
•    regularly used medicines and supplements (ideally present a written list right before the blood test)
•    infectious diseases you suffer from (HIV, hepatitis, mononucleosis...)
•    contact with an infected person or presence in an infectious environment

[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]Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, Cooper C, Rizzoli R, Adib G, Al-Daghri N, Campusano C, Chandran M, Dawson-Hughes B, Javaid K, Jiwa F, Johansson H, Lee JK, Liu E, Messina D, Mkinsi O, Pinto D, Prieto-Alhambra D, Saag K, Xia W, Zakraoui L, Reginster J-. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int. 2020 Jan;31(1):1-12. Erratum in: Osteoporos Int. 2020 Apr;31(4):797-798.

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