Research article

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

Bianca Dumitrescu^1,2 , Svenjhalmar van Helden³ , Rene ten Broeke⁴ , Arie Nieuwenhuijzen-Kruseman⁵ , Caroline Wyers⁶ , Gabriela Udrea² , Sjef van der Linden¹ and Piet Geusens^1,7

¹Department of Internal Medicine, Subdivision of Rheumatology, University Hospital, Maastricht, The Netherlands

²Department of Rheumatology, University of Medicine and Pharmacy 'Carol Davila' Bucharest, Romania

³Department of Trauma Surgery, University Hospital, Maastricht, The Netherlands

⁴Department of Orthopaedic Surgery, University Hospital, Maastricht, The Netherlands

⁵Department of Internal Medicine, Division of Endocrinology, University Hospital, Maastricht, The Netherlands

⁶Epidemiology, Maastricht University, The Netherlands

⁷Biomedical Research Centre, University Hasselt, Belgium

author email corresponding author email

BMC Musculoskeletal Disorders 2008, 9:109doi:10.1186/1471-2474-9-109

Published:	5 August 2008

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 ≤-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.