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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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Calcium intake and serum serum levels of 25OHD3. Only 3 patients had sufficient intake of calcium and normal serum levels of 25-OHD3.
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Figure 2: Calcium intake and serum serum levels of 25OHD3. Only 3 patients had sufficient intake of calcium and normal serum levels of 25-OHD3.

Mentions: Based on serum levels of 25-OHD3, 11 patients had severe deficiency, 31 were deficient and 31 had insufficient serum values. All were newly diagnosed. Serum levels of 25-OHD3 could not be predicted by any of questions on vitamin D or by the sum of those questions. Calcium intake below 1200 mg was reported in 86 patients. Only three patients had both a calcium intake above 1200 mg and a serum 25-OHD3 level above 75 nmol/L (Figure 2).


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)

Calcium intake and serum serum levels of 25OHD3. Only 3 patients had sufficient intake of calcium and normal serum levels of 25-OHD3.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Calcium intake and serum serum levels of 25OHD3. Only 3 patients had sufficient intake of calcium and normal serum levels of 25-OHD3.
Mentions: Based on serum levels of 25-OHD3, 11 patients had severe deficiency, 31 were deficient and 31 had insufficient serum values. All were newly diagnosed. Serum levels of 25-OHD3 could not be predicted by any of questions on vitamin D or by the sum of those questions. Calcium intake below 1200 mg was reported in 86 patients. Only three patients had both a calcium intake above 1200 mg and a serum 25-OHD3 level above 75 nmol/L (Figure 2).

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