Contributors to Secondary Osteoporosis and Metabolic Bone Diseases in Patients Presenting with a Clinical Fracture.
J Clin Endocrinol Metab. 2011 Mar 16.
Bours SP, van Geel TA, Geusens PP, Janssen MJ, Janzing HM, Hoffland GA, Willems PC, van den Bergh JP.
Department of Internal Medicine (S.P.G.B., J.P.W.v.d.B.), Laboratory of Clinical Chemistry and Haematology (M.J.W.J.), Department of Surgery (H.M.J.J.), Department of Radiology (G.A.H.), VieCuri Medisch Centrum Noord-Limburg, 5912 BL Venlo, The Netherlands; Department of Internal Medicine (S.P.G.B.), Subdivision Endocrinology, and Department of Orthopedic Surgery (P.C.W.), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands; Department of General Practice (T.A.C.M.v.G.), Department of Internal Medicine (P.P.M.M.G.), Subdivision Rheumatology, Maastricht University/CAPHRI School for Public Health and Primary Care, 6200 MD Maastricht, The Netherlands; Biomedical Research Centre (P.P.M.M.G.), University Hasselt, B-3590 Diepenbeek, Belgium; and Department of Internal Medicine (J.P.W.v.d.B.), Maastricht University Medical Centre/School for Nutrition, Toxicology, and Metabolism, 6200 MD Maastricht, The Netherlands.
Background: Previously undetected contributors to secondary osteoporosis and metabolic bone diseases (SECOB) are frequently found in patients with osteoporosis, but the prevalence in patients at the time they present with a clinical fracture is unknown.
Methods: All consecutive patients with a recent clinical vertebral or nonvertebral fracture, who were able and willing to be investigated (n = 626: 482 women, 144 men, age range 50-97 yr) had bone mineral density and laboratory investigations (serum calcium, inorganic phosphate, 25-hydroxyvitamin D, creatinine, intact PTH, TSH, free T(4), serum and urine protein electrophoresis, and in men also serum testosterone).
Results: Known SECOB contributors were present in 23.0% of patients and newly diagnosed SECOB contributors in 26.5%: monoclonal proteinemia (14 of 626), renal insufficiency grade III or greater (54 of 626), primary (17 of 626) and secondary (64 of 626) hyperparathyroidism, hyperthyroidism (39 of 626), and hypogonadism in men (12 of 144). Newly diagnosed SECOBs, serum 25-hydroxyvitamin D less than 50 nmol/liter (in 63.9%), and dietary calcium intake less than 1200 mg/d (in 90.6%) were found at any age, in both sexes, after any fracture (except SECOB in men with finger and toe fractures) and at any level of bone mineral density.
Conclusion: At presentation with a fracture, 26.5% of patients have previously unknown contributors to SECOB, which are treatable or need follow-up, and more than 90% of patients have an inadequate vitamin D status and/or calcium intake. Systematic screening of patients with a recent fracture identifies those in whom potentially reversible contributors to SECOB and calcium and vitamin D deficiency are present.
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