Internal medicine inpatients' prevalence of misdiagnosed severe osteoporosis.
Diagnostic errors
Fragility fractures
Severe osteoporosis
Spinal fracture
Journal
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
ISSN: 1433-2965
Titre abrégé: Osteoporos Int
Pays: England
ID NLM: 9100105
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
28
01
2021
accepted:
22
04
2021
pubmed:
6
5
2021
medline:
5
11
2021
entrez:
5
5
2021
Statut:
ppublish
Résumé
Vertebral fractures (VF) related to osteoporosis (i.e., severe OP) increase the risk of disability and mortality, but they are often neglected. We observed a severe OP misdiagnosis in 28.9% of inpatients with previous spinal imaging positive for VFs. Diagnosing severe OP is crucial to reduce the health care costs of inpatients. Vertebral fractures (VFs) related to osteoporosis (OP) increase the risk of additional fractures and death. In inpatients, VFs are often neglected with consequent delay in OP treatments, prolongation of hospitalization, and reduction of life expectancy. The aim of this study was to evaluate the prevalence of a misdiagnosed severe OP (i.e., with VF) in general medicine inpatients. We evaluated inpatients of a Medicine Unit between January 2019 and December 2019 without severe OP diagnosis, who had spinal imaging. For each patient, we collected demographic data, previous or current OP treatment, and presence/number of VFs. Descriptive data were presented by medians (interquartile range [IQR]) for continuous data or as numbers (percentages) for categorical data. Differences between subgroups were analyzed with chi-square or Kruskal-Wallis tests as appropriate. p-values <0.05 were considered statistically significant. 793 subjects were admitted to inpatient's clinic: 235 (135 females and 100 males with a median age of 76.0 [64.0-83.0] years) were enrolled. One or more vertebral fractures were present in 28.9% (68/235) subjects; 47% (32/68) had two or more vertebral fractures. The majority of patients (55/68) with VFs had not previously received a severe OP diagnosis. Severe OP was misdiagnosed in at least 8.6% of inpatients. The prevalence dramatically increases (about 29%) in subjects with previous spinal imaging showing one or more VFs. More attention should be given to this co-morbidity, which is known to be an additional risk factor for disability and mortality.
Identifiants
pubmed: 33950266
doi: 10.1007/s00198-021-05976-6
pii: 10.1007/s00198-021-05976-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2361-2364Informations de copyright
© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.
Références
Royal Osteoporosis Society, Clinical guidance for the effective identification of vertebral fractures, Nov 2020
Nuti R, Brandi ML, Isaia G, Tarantino U, Silvestri S, Adami S (2009) New perspectives on the definition and management of severe osteoporosis: the patient with two or more fragility fractures. J Endocrinol Invest 32(9):783–788
doi: 10.1007/BF03346537
Fernandez-Avila DG, Riancon-Riano DN, Pinzon DF, Gutierrez Davila JM (2019) Low rate of densitometric diagnosis and treatment in patients with severe osteoporosis in Colombia. Arch Osteoporos 14:95
doi: 10.1007/s11657-019-0646-6
Kanis JA, Cooper C, Rizzoli R, Reginster JY (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30:3–44
doi: 10.1007/s00198-018-4704-5
Ismail A, Cockerill W, Cooper C et al (2001) Prevalent vertebral deformity predict incident hip though not distal forearm fracture: results from the European prospective Osteoporosis Study. Osteoporos Int 12:85–90
doi: 10.1007/s001980170138
Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res 14(N 5)
Santamaría Fernández S, Miralles F, Ruiz Serrato A, García Alegría J, Ruiz Cantero A, García Ordoñez MA (2012 Mar) San Román Terán CM, González Zorzano E, Gómez-Huelgas R. Prevalence of thoracic vertebral fractures in Spanish patients hospitalized in internal medicine departments. Assessment of the clinical inertia. (PREFRAMI study). Eur J Intern Med 23(2):e44–e47. https://doi.org/10.1016/j.ejim.2011.11.015
doi: 10.1016/j.ejim.2011.11.015
pubmed: 22284255
Pizzato S, Trevisan C, Lucato P, Girotti G, Mazzochin M, Zanforlini BM, Bano G, Piovesan F, Bertocco A, Zoccarato F, Dianin M, Manzato E, Sergi G (2018, Aug) Identification of asymptomatic frailty vertebral fractures in postmenopausal women. Bone 113:89–94
doi: 10.1016/j.bone.2018.05.007
Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582
doi: 10.1007/s001980070078
Vitali C, Gussoni G, Bianchi G, Albanese CV, Diacinti D, Sinigaglia L, Nuti R, Muzzulini CL, Pintaudi C, Scanelli G, Magni G, Valerio A, Iori I, Mazzone A, Campanini M (2015) for the Research Department of FADOI, High prevalence of fragility vertebral fractures in patients hospitalised in Internal Medicine Units. Results of the POINT (Prevalence of Osteoporosis in INTernal medicine) study. Bone 74:114–120
doi: 10.1016/j.bone.2015.01.012
Rossini M, Amani S, Bertoldo F, Diacinti D, Gatti D, Giannini S, Giusti A, Malavolta N, Minisola S, Osella G, Pedrazzoni M, Sinigaglia L, Viapiana O, Isaia GC (2016) Linee guida per la diagnosi, la prevenzione ed il trattamento dell'osteoporosi. Reumatismo 68(1):1–42
doi: 10.4081/reumatismo.2016.870
Kendler DL, Bauer DC, Davison KS, Dian L, Hanley DA, Harris ST, McClung MR, Miller PD, Schousboe JT, Yuen CK, Lewiecki EM 2016 Vertebral fractures: clinical importance and management, the American Journal of Medicine, Vol 129, No2
Lunt M, O'Neill T, Felsenberg D, Reeve J, Kanis JA, Cooper C, Silman A (2003) and the European Prospective Osteoporosis Study Group. Bone 33:505–513
doi: 10.1016/S8756-3282(03)00248-5
Weycker D, Li X, Barron R, Bornheimer R, Chandler D (2016) Hospitalizations for osteoporosis-related fractures: Economic costs and clinical outcomes. Bone Reports 5:186–191
doi: 10.1016/j.bonr.2016.07.005
Marcellusi A, Rotundo MA, Nardone C, Sciattella P, Gazzillo S, Rossini M, Barbagallo M, Antenori A, Valle D, Mennini FS (2020) Osteoporosis: economic burden of disease in Italy. Clinical Drug Investigation 40:449–458
doi: 10.1007/s40261-020-00904-8
Delmas P.D, van de Langerijt L, Watts N, Eastell R, Genant H, Grauer A, Cahall D 2005 Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT Study, Journal of Bone and Mineral Research, Vol 20, N 4