Men's Osteoporosis Support Group
Contributors to Secondary Osteoporosis and Metabolic Bone Diseases in Patients Presenting with a Clinical Fracture
J Clin Endocrinol Metab. 2011 Mar 16. [Epub ahead of print]. Contributors to Secondary Osteoporosis and Metabolic Bone Diseases in Patients Presenting with a Clinical Fracture. Bours SP and others. PMID: 21411547. Osteoporosis can be primary or secondary. This study evaluated the possible contributors to secondary osteoporosis and metabolic bone diseases (SECOB) when older individuals first presented with a clinical fracture of a vertebra or other bone. It involved 482 women and 144 men aged from 50-97 years.
When the patients presented with fractures, multiple tests were done to determine if anything that had not been previously known about their medical condition could contribute to the secondary osteoporosis. They found 23% of patients did have known contributors while 26.5% had unknown ones.
The authors conclude, “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.” [Emphasis mine]
Editor's comments. The low levels of vitamin D and calcium intake, which affected 90% of patients, stand out as the most easily treated secondary osteoporosis sources. In short, there would be little need for testing of vitamin D or calcium, all people (at least in The Netherlands) need supplements, added sun exposure, or a diet richer in calcium/vitamin D. It is likely that 90% figure is accurate in many other countries, too. But the results also show that many other known SECOB contributors were present, but undiagnosed, at the time of fracture. The authors suggest that systematic screening of all older patients when they present with fracture will elucidate these secondary risk factors, and presumably help prevent additional fractures.
The bottom line for older individuals is that a fracture, particularly a low-trauma fracture, should be followed up with a full osteoporosis workup. Assume you have primary or secondary osteoporosis, and then find out which one. Secondary osteoporosis needs more than just taking an FDA-approved osteoporosis medication.