Secondary contributors to bone loss in osteoporosis related hip fractures
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Osteoporosis treatment of patients with hip fractures is necessary to prevent subsequent fractures. Secondary causes for bone loss are present in more than 80% of patients with hip fractures, and therefore, assessment of Vitamin D status, disorders in calcium absorption and excretion, monoclonal gammopathies, and renal function should be performed. Identifying and managing these disorders will improve detection and enhance treatment aimed at reducing the risk of recurrent fractures in older adults.
The purpose of this study was to determine the prevalence of disorders affecting bone and mineral metabolism in individuals with osteoporotic hip fractures.
Community dwelling individuals with hip fractures (HFx) 50 years of age and older. Assessment for vitamin D, renal and parathyroid status, calcium absorption, and plasma cell disorders.
Of 157 HFx, mean age 70 ± 10 years, HFx had higher creatinine (p = 0.002, 95% C.I. −0.09, 0.05); lower 25 OH vitamin D (p = 0.019, 95% C.I. 6.5, 2.7), albumin (p = 0.007, 95% C.I. 0.36, 0.009), and 24-h urine calcium (p = 0.024, 95% CI 51, 21) as compared to controls. More than 80% of HFx had at least one previously undiagnosed condition, with vitamin D insufficiency (61%), chronic kidney disease (16%) (CKD), monoclonal gammopathy (6%), and low calcium absorption (5%) being the most common. One case each of multiple myeloma and solitary plasmocytoma were identified.
Osteoporosis treatment of HFx is necessary to prevent subsequent fractures. Secondary causes for bone loss are remarkably common in HFx; therefore, assessment of vitamin D status, disorders in calcium absorption and excretion, protein electrophoresis, and renal function should be performed. Identifying and correcting these disorders will improve detection and enhance treatment aimed at reducing the risk of recurrent fractures in older adults.
KeywordsChronic kidney disease Fractures Myeloma Osteoporosis Vitamin D
Conflicts of interest
- 1.US Department of Health and Human Services, Bone Health and Osteoporosis: A report of the Surgeon General. Rockville MD: U.S. Department of Health and Human Services, Office of the Surgeon General; 2004Google Scholar
- 4.National Osteoporosis Foundation (1998) Osteoporosis review of the evidence for prevention, diagnosis and treatment, and cost effectiveness Analysis. Osteoporos Int Suppl4:S1–S85Google Scholar
- 5.Lyles KW, Colon-Emeric CS, Magaziner J et al (2007) Efficacy and safety of Zoledronic acid 5 mg in preventing fractures in men and women with prevalent hip fractures: the horizon recurrent hip fractures trial. New Engl J Med (in press)Google Scholar
- 6.Edwards BJ, Bunta AD, Madison LD et al (2005) An osteoporosis and fracture intervention program increases the diagnosis and treatment for osteoporosis for patients with minimal trauma fractures. Jt Comm J Qual Patient Saf 5:267–274Google Scholar
- 9.American Orthopaedic Association (2005) Leadership in orthopaedics: taking a stand to own the bone. J Bone Joint Surg Am 87A:1388–1391Google Scholar
- 20.Gunter EW, Lewis BL, Koncikowski SM (1996) Laboratory methods used for the third National Health and Nutrition Examination Survey (NHANES III),1988–1994. Hyattsville, MD: Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/about/major/nhanes/NHANESIII_. Accessed 7/10/2006.
- 22.Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Int Med 134:161–170Google Scholar
- 32.Bischoff HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW (2004) Higher 25 Hydroxyvitamin D concentrations are associated with better lower extremity function in both active and inactive persons aged > 60 y. Am J Clin Nutr 80:752–758Google Scholar
- 50.Miller PD, Roux C, Boonen S, Barton IP, Dunlap LE, Burgio DE (2005) Safety and efficacy of risedronate in patients with age-related reduced renal function as estimated by the cockcroft and gault method: a pooled analysis of nine clinical trials. J Bone Miner Res 20:2105–2115PubMedCrossRefGoogle Scholar
- 55.Coyne D (2007) Chronic kidney disease and secondary hyperparathyroidism. Annual Meeting: International Society of Clinical Densitometry. TampaGoogle Scholar
- 56.USRDS: Annual Data Report C (1999) Incidence and prevalence of ESRD. Am J Kidney Dis 34:540–550Google Scholar
- 57.Ritz E, Rychlik I, Locatelli F, Halimi S (1999) End-stage renal failure in type 2 diabetes, a medical catastrophe of worldwide dimensions. Am J Kidney Dis 34(795–808)Google Scholar
- 65.Lyles KW, Colon-Emeric CS, Pieper C et al (2007) The Horizon clinical fracture after recent hip fracture trial (RFT) study cohort description (SA405). American Society of Bone and Mineral Research. Honolulu, HawaiiGoogle Scholar
- 68.Food and Nutrition Board, Institute of Medicine (1997) Dietary reference intakes for calcium, magnesium, phosphorus, vitamin D, and fluoride. Washington, DCGoogle Scholar
- 75.American Association of Clinical Endocrinologists (2002) American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients—2002 update. Endocr Pract 8(6):440–456Google Scholar