Secondary osteoporosis in patients with a recent clinical fracture and low bone mineral density

Abstract

Osteoporosis is a multifactorial bone disease that results in fragility fractures with significant morbidity, mortality, health- and social costs. Relatively little attention has been paid to the medical evaluation of patients with a clinical fracture. We therefore investigated bone-and fall-related risks for fractures along with causes of secondary osteoporosis in patients admitted to the hospital because of a recent clinical fracture. All patietns older than 50 years, who presented at the hospital with a fracture, had fracture and fall risk evaluation according to the Dutch guidelines, including bone densitometry. Patients with a T-score ≤−2.5 in the hip and/or spine were further investigated for secondary osteoporosis. We evaluated 100 consecutive and consenting patients, 73 women and 27 men with a mean age of 68 years (50-90 years). Sixty-six had contributors to secondary osteoporosis. Forty-one patients had previously undiagnosed vitamin D deficiency (≤50 nmol/l), 28 had endocrine diseases (13 known thyroid pathologies, 1 primary, 5 secondary undiagnosed hyperparathyroidism (PTH >5.5 pmol/l), three men had unknown hypogonadism (testosterone <9.4 nmol/l), 14 had known renal insufficiency (creatinine clearance <40 ml/min)), six had inflammatory rheumatic diseases and four men had alcohol abuse. Thirty patients reported history of non-vertebral fracture and one history of a clinical vertebral fracture. On morphometry 61 patients had prevalent vertebral fractures. There were 54 patients with clinical fracture risks (73 when morphometry included), 79 had fall risks and 61 had both fall and fracture risks, including morphometric vertebral fractures. We conclude that secondary osteoporosis is frequent in patients entering the hospital with a recent clinical fracture and a T-score ≤−2.5. Nearly two in three had previously undiagnosed morphometric vertebral fractures.