Secondary osteoporosis in patients with a recent clinical fracture.

Abstract

Osteoporosis is a multifactorial metabolic bone disease that results in fragility fractures with significant morbidity, mortality, health and social costs. We investigated the fracture, fall risk profile and causes of secondary osteoporosis in patients with a recent clinical fracture. All women and men, older than 50 years who presented to the hospital with a fracture were offered fracture and fall risk evaluation according to the Dutch guidelines, including bone densitometry by dual X-ray absorptiometry (DXA). Patients with aT-score <-2.5 in the hip and/or spine were further investigated for secondary osteoporosis. This included a set of laboratory tests performed in all (ESR, hemoglobin, leucocytes, creatinine, calcium in serum and 24-hours urine, alkaline phosphatase, phosphate, 25(OH) vitamin D, TSH) and other tests when appropriate. In addition. morphometry of the vertebrae was performed using DXA (anterior, mid or posterior height loss of>20%). We evaluated 72 consecutive and consenting patients with aT-score <-2.5, 57 women (79%) and 15 men (21%) mean age of69 years. 37 (51%) had secondary osteoporosis or other associated diseases. Thirty patients (42%) had undiagnosed vitamin D deficiency (0":50 nmol/I), 21 (29%) had endocrine diseases (10 known thyroid pathologies, 5 undiagnosed hyperparathyroidism(PTH>5,5 pmol/l), 2 men with unknown hypogonadism (testosterone <9.4nmol/I), 8 (11%) had renal insufficiency (creatinine clearance <40ml/ min», 4 (6%) had inflammatory rheumatic diseases and 3 (4%) had alcohol abuse. Thirty (42%) patients reported a history of non-vertebral fracture and one a history of a clinical vertebral fracture. On morphometry 40(56%) patients had a prevalent vertebral fracture. There were 35 patients with clinical fracture risks (49%), but 52 (72%) when morphometry was included, 61 had fall risks (85%) and 60% had both fracture and fall risks. Secondary osteoporosis is frequent in patients entering the hospital with a recent clinical fracture and aT-score <-2.5. More than half had previously undiagnosed vertebral fractures. Several causes were undiagnosed and correctable and/or preventable such as vitamin D deficiency and endocrine diseases. These results suggest that patients with a recent clinical fracture and osteoporosis deserve targeted evaluation, including the detection of undiagnosed vertebral fractures.