The yield of routine laboratory examination in osteoporosis evaluation in primary care.
Bone density
Clinical chemistry tests
Fractures
Osteoporosis
Primary health care
Vitamin D deficiency
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:
18 Mar 2024
18 Mar 2024
Historique:
received:
25
09
2023
accepted:
14
02
2024
medline:
18
3
2024
pubmed:
18
3
2024
entrez:
18
3
2024
Statut:
aheadofprint
Résumé
This study evaluated the yield of routine laboratory examination in a large population of older women in primary care. The prevalence of laboratory abnormalities was low and the clinical consequences in follow-up were limited. There was a weak association of laboratory abnormalities with osteoporosis but no association with vertebral fractures and recent fractures. Most osteoporosis guidelines advice routine laboratory examination. We have investigated the yield of laboratory examinations in facture risk evaluation of elderly women in primary care. We assessed the prevalence of laboratory abnormalities and their association with risk factors for fractures, recent fractures, low bone mineral density (BMD), and prevalent vertebral fracture in 8996 women ≥ 65 years of age participating in a primary care fracture risk screening study. In a sample of 2208 of these participants, we also evaluated the medical consequences in the medical records during a follow-up period of ≥ 1 year. Vitamin D deficiency (< 30 nmol/L) was present in 13% and insufficiency (< 50 nmol/L) in 43% of the study sample. The prevalence of other laboratory abnormalities (ESR, calcium, creatinine, FT4) was 4.6% in women with risk factors for fractures, 6.1% in women with low BMD (T-score ≤ - 2.5), 6.0% after a prevalent vertebral fracture, 5.2% after a recent fracture and 2.6% in the absence of important risk factors for fractures. Laboratory abnormalities other than vitamin D were associated with low BMD (OR 1.4, 95%CI 1.1-1.8) but not with prevalent vertebral fractures nor recent fractures. Low BMD was associated with renal failure (OR 2.0, 95%CI 1.3-3.4), vitamin D insufficiency (OR 1.2, 95%CI 1.0-1.3) and deficiency (OR 1.3, 95%CI 1.1-.5). In the follow-up period, 82% of the laboratory abnormalities did not result in a new diagnosis or treatment reported in the medical records. We identified a low prevalence of laboratory abnormalities in a primary care population of older women and the majority of these findings had no medical consequences.
Identifiants
pubmed: 38494549
doi: 10.1007/s00198-024-07042-3
pii: 10.1007/s00198-024-07042-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Svedbom A, Borgstrom F, Hernlund E, Strom O, Alekna V et al (2018) Quality of life up to 18 months after low-energy hip, vertebral, and distal forearm fractures- results from the ICUROS. Osteopor Int 29(3):557–566. https://doi.org/10.1007/s00198-017-4317-4
doi: 10.1007/s00198-017-4317-4
Abrahamsen B, van Staa T, Ariely R, Olsen M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteopor Int 20(10):1633–1650. https://doi.org/10.1007/s00198-009-0920-3
doi: 10.1007/s00198-009-0920-3
LeBoff MA, Greenspan SL, Insogna KL, Lewieki EM, Singer AJ, Siris ES (2022) The clinician’s guide to prevention and treatment of osteoporosis. Ost Int 33(10):2049–2102. https://doi.org/10.1007/s00198-021-05900-y
doi: 10.1007/s00198-021-05900-y
Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS. Farooko A, Harris ST, Hurley DL, Kelly J, Lewiecki EM, Pessah-Pollack R, McClung M, Wimalawansa SJ, Watts NB (2020) American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract 26(Supple 1):1–46. https://doi.org/10.4158/GL-2020-0524SUPPL
Kanis JA, Cooper C, Rizzoli R, Reginser JY (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30(1):3–44. https://doi.org/10.1007/s00198-018-4704-5
doi: 10.1007/s00198-018-4704-5
pubmed: 30324412
Gregson CL, Armstrong DJ, Bowden J, Cooper C, Edwards J, Gittoes NJL, Harvey N, Kanis J, Leyland S, Low R, McCloskey E, Moss K, Parker J, Paskins Z, Poole K, Reid DM, Stone M, Thomson J, Vine N, Comston J (2022) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporosis 17(1):58. https://doi.org/10.1007/s11657-022-01061-5
doi: 10.1007/s11657-022-01061-5
Bours SPG, Van de Bergh JPW, Geel TACM, Geusens PPMM (2014) Secondary osteoporosis and metabolic bone disease in patients 50 years and older with osteoporosis or with a recent clinical fracture: a clinical perspective. Curr Opin Rheumatol 26(4):430–439. https://doi.org/10.1097/BOR.0000000000000074
doi: 10.1097/BOR.0000000000000074
pubmed: 24841229
Tannenbaum C, Clark J, Schwartzman K et al (2002) Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J Clin Endocrinol Metab 87:4431–4437. https://doi.org/10.1210/jc.2002-020275
doi: 10.1210/jc.2002-020275
pubmed: 12364413
Deutschmann H, Weger M, Weger W et al (2002) Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J Intern med 252:389–397. https://doi.org/10.1046/j.1365-2796.2002.01040.x
doi: 10.1046/j.1365-2796.2002.01040.x
pubmed: 12528756
Freitag A, Barzel US (2002) Differential diagnosis of osteoporosis. Gerontology 48:98–102. https://doi.org/10.1159/000048934
doi: 10.1159/000048934
pubmed: 11867932
Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM (2020) Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Ost Int 31(2):251–257. https://doi.org/10.1007/s00198-019-05226-w
doi: 10.1007/s00198-019-05226-w
McCloskey EV, Chotiyarnwong P, Harvey NC, Lorentzon M, Kanis JA (2022) Population screening for risk in postmenopausal women- a logical step in reducing the osteoporotic fracture burden. Ost Int 33(8):1631–1637. https://doi.org/10.1007/s00198-022-06419-6
doi: 10.1007/s00198-022-06419-6
Chotiayarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D et al (2022) Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the international Osteoporosis Foundation Epidemiologie/Quality of Life Working Group. Arch Osteoporos 17(1):87. https://doi.org/10.1007/s11657-022-01117-6
doi: 10.1007/s11657-022-01117-6
Elders PJM, Merlijn T, Swart KMA et al (2017) Design of the SALT Osteoporosis Study: a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older. BMC Musculoskelet Disord 18(1):424. https://doi.org/10.1186/s12891-017-1783-y
doi: 10.1186/s12891-017-1783-y
pubmed: 29078762
pmcid: 5658954
Merlijn T, Swart KMA, van Schoor NM, Heymans MW, van der Zwaard BC, van der Heijden AA, Rutters F, Lips P, van der Horst HE, Niemeijer C, Netelenbos JC, Elders PJM (2019) The effect of a screening and treatment program for the prevention of fractures in older women: a randomized trial. JBMR 34(11):1993–2000. https://doi.org/10.1002/jbmr.3815
doi: 10.1002/jbmr.3815
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiqantitative technique. J Bone Miner Res 8:1137–1148. https://doi.org/10.1002/jbmr.5650080915
doi: 10.1002/jbmr.5650080915
pubmed: 8237484
van Boven K, ten Napel H (2021) ICPC-3 International Classification of Primary Care: user manual and classification. CRC Press, Boca Raton. ISBN 9781003197157
Health Council of the Netherlands (2012) Evaluation of the dietary reference values for vitamin D. Health Council of the Netherlands, The Hague
Merlijn T, Swart KMA, Lips P, Heymans MW, Sohl E, Van Schoor NM, Netelenbos CJ, Elders PJM (2018) Prediction of insufficient serum vitamin D status in older women: a validated model. Ost Int 29(7):1539–1547. https://doi.org/10.1007/s00198-018-4410-3
Bours SPG, Geel TACM, Geusens PPMM, Janssen MJW, Janzing HMJ, Hoffland GA, Willems PC, Van de Bergh JPW (2011) Contributors to secondary osteoporosis and metabolic bone disease in patients presenting with a clinical fracture. J Clin Endocrinol Metab 96:1360–1367. https://doi.org/10.1210/jc.2010-2135
doi: 10.1210/jc.2010-2135
pubmed: 21411547
Malgo F, Appelman-Dijkstra NM, Termaat MF, Van der Heide HJL, Schipper IB, Rabelink TJ, Hamdy NAT (2016) High prevalence of secondary factors for bone fragility in patients with recent fracture independently of BMD. Arch Osteoporos 11:12. https://doi.org/10.1007/s11657-016-0258-3
doi: 10.1007/s11657-016-0258-3
pubmed: 26906974
pmcid: 4764633
de Klerk G, Hegeman JH, van der Velde D, van der Palen J, van Bergeijk L, ten Duis HJ. The value of laboratory tests in diagnosing secondary osteoporosis at a fracture and osteoporosis outpatient clinic. Geriatr Orthop Surg Rehabil 4(2):53–57. https://doi.org/10.1177/2151458513501176
Jamal SA, Leiter RE, Bayoumi AM, Bauer DC, Cummings SR (2005) Clinical utility of laboratory testing in women with osteoporosis. Osteoporos Int 16:534–540. https://doi.org/10.1007/s00198-004-1718-y
doi: 10.1007/s00198-004-1718-y
pubmed: 15340801
Fink HA, Litwack-Harrison S, Taylor BC, Bauer DC, Orwoll ES, Lee CG, Barrett-Connor E, Schousboe JT, Kado DM, Garimella PS, Ensrud (2016) Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the Osteoporotic Fractures in Men (MrOs) Study Group. Osteoporos Int 27(1):331–338. https://doi.org/10.1007/s00198-015-3356-y