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Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach.

Dumitrescu B, van Helden S, ten Broeke R, Nieuwenhuijzen-Kruseman A, Wyers C, Udrea G, van der Linden S, Geusens P - BMC Musculoskelet Disord (2008)

Bottom Line: The 57 patients with contributors were older (71 vs. 64 yrs, p < 0.01), had more vertebral deformities (67% vs. 44%, p < 0.05) and a higher calculated absolute 10-year risk for major (16.5 vs. 9.9%, p < 0.01) and for hip fracture (6.9 vs. 2.4%, p < 0.01) than patients without contributors.We conclude that more than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable.Identifying and correcting these associated disorders will enhance treatment effect aimed at reducing the risk of subsequent fractures in patients older than 50 years.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Subdivision of Rheumatology, University Hospital, Maastricht, The Netherlands. bia1mar@yahoo.com

ABSTRACT
The aetiology of osteoporotic fractures is multifactorial, but little is known about the way to evaluate patients with a recent clinical fracture for the presence of secondary osteoporosis. The purpose of this study was to determine the prevalence of contributors to secondary osteoporosis in patients presenting with a clinical vertebral or non-vertebral fracture. Identifying and correcting these contributors will enhance treatment effect aimed at reducing the risk of subsequent fractures. In a multidisciplinary approach, including evaluation of bone and fall-related risk factors, 100 consecutive women (n = 73) and men (n = 27) older than 50 years presenting with a clinical vertebral or non-vertebral fracture and having osteoporosis (T-score < or =-2.5) were further evaluated clinically and by laboratory testing for the presence of contributors to secondary osteoporosis. In 27 patients, 34 contributors were previously known, in 50 patients 52 new contributors were diagnosed (mainly vitamin D deficiency in 42) and 14 needed further exploration because of laboratory abnormalities (mainly abnormal thyroid stimulating hormone in 9). The 57 patients with contributors were older (71 vs. 64 yrs, p < 0.01), had more vertebral deformities (67% vs. 44%, p < 0.05) and a higher calculated absolute 10-year risk for major (16.5 vs. 9.9%, p < 0.01) and for hip fracture (6.9 vs. 2.4%, p < 0.01) than patients without contributors. The presence of contributors was similar between women and men and between patients with fractures associated with a low or high-energy trauma. We conclude that more than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable. Identifying and correcting these associated disorders will enhance treatment effect aimed at reducing the risk of subsequent fractures in patients older than 50 years.

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Flow chart of patients included in the study (see text for details) in one year.
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Figure 1: Flow chart of patients included in the study (see text for details) in one year.

Mentions: In this prospective observational study, 100 consecutive and consenting patients older than 50 years, who presented between April 2005 and April 2006 with a clinical fracture at Maastricht University Hospital in the Netherlands, were included. After receiving medical treatment for the fracture, patients had a consultation with the fracture nurse. The fracture nurse provided information about the study and invited the patients to the Fracture and Osteoporosis Outpatient Clinic. Patients already on osteoporosis treatment (44/1246, 4% of all) or with pathological fractures due to malignancy or Paget's disease of bone were excluded from the analysis. Patients who agreed to participate were further referred to the program. Patients with osteoporosis according to World Health Organization (WHO) criteria for BMD [4] and in whom all laboratory data were available were included in the present study (Figure 1). This group was part of the evaluation of all consecutive patients presenting with a clinical fracture, of whom 35% had osteoporosis and 44% had osteopenia [1]. The medical ethical committee of the University Hospital Maastricht approved the study (MEC 03-194-5).


Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach.

Dumitrescu B, van Helden S, ten Broeke R, Nieuwenhuijzen-Kruseman A, Wyers C, Udrea G, van der Linden S, Geusens P - BMC Musculoskelet Disord (2008)

Flow chart of patients included in the study (see text for details) in one year.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2529301&req=5

Figure 1: Flow chart of patients included in the study (see text for details) in one year.
Mentions: In this prospective observational study, 100 consecutive and consenting patients older than 50 years, who presented between April 2005 and April 2006 with a clinical fracture at Maastricht University Hospital in the Netherlands, were included. After receiving medical treatment for the fracture, patients had a consultation with the fracture nurse. The fracture nurse provided information about the study and invited the patients to the Fracture and Osteoporosis Outpatient Clinic. Patients already on osteoporosis treatment (44/1246, 4% of all) or with pathological fractures due to malignancy or Paget's disease of bone were excluded from the analysis. Patients who agreed to participate were further referred to the program. Patients with osteoporosis according to World Health Organization (WHO) criteria for BMD [4] and in whom all laboratory data were available were included in the present study (Figure 1). This group was part of the evaluation of all consecutive patients presenting with a clinical fracture, of whom 35% had osteoporosis and 44% had osteopenia [1]. The medical ethical committee of the University Hospital Maastricht approved the study (MEC 03-194-5).

Bottom Line: The 57 patients with contributors were older (71 vs. 64 yrs, p < 0.01), had more vertebral deformities (67% vs. 44%, p < 0.05) and a higher calculated absolute 10-year risk for major (16.5 vs. 9.9%, p < 0.01) and for hip fracture (6.9 vs. 2.4%, p < 0.01) than patients without contributors.We conclude that more than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable.Identifying and correcting these associated disorders will enhance treatment effect aimed at reducing the risk of subsequent fractures in patients older than 50 years.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Subdivision of Rheumatology, University Hospital, Maastricht, The Netherlands. bia1mar@yahoo.com

ABSTRACT
The aetiology of osteoporotic fractures is multifactorial, but little is known about the way to evaluate patients with a recent clinical fracture for the presence of secondary osteoporosis. The purpose of this study was to determine the prevalence of contributors to secondary osteoporosis in patients presenting with a clinical vertebral or non-vertebral fracture. Identifying and correcting these contributors will enhance treatment effect aimed at reducing the risk of subsequent fractures. In a multidisciplinary approach, including evaluation of bone and fall-related risk factors, 100 consecutive women (n = 73) and men (n = 27) older than 50 years presenting with a clinical vertebral or non-vertebral fracture and having osteoporosis (T-score < or =-2.5) were further evaluated clinically and by laboratory testing for the presence of contributors to secondary osteoporosis. In 27 patients, 34 contributors were previously known, in 50 patients 52 new contributors were diagnosed (mainly vitamin D deficiency in 42) and 14 needed further exploration because of laboratory abnormalities (mainly abnormal thyroid stimulating hormone in 9). The 57 patients with contributors were older (71 vs. 64 yrs, p < 0.01), had more vertebral deformities (67% vs. 44%, p < 0.05) and a higher calculated absolute 10-year risk for major (16.5 vs. 9.9%, p < 0.01) and for hip fracture (6.9 vs. 2.4%, p < 0.01) than patients without contributors. The presence of contributors was similar between women and men and between patients with fractures associated with a low or high-energy trauma. We conclude that more than one in two patients presenting with a clinical vertebral or non-vertebral fracture and BMD-osteoporosis have secondary contributors to osteoporosis, most of which were correctable. Identifying and correcting these associated disorders will enhance treatment effect aimed at reducing the risk of subsequent fractures in patients older than 50 years.

Show MeSH
Related in: MedlinePlus