Laboratory evaluation of secondary causes of bone loss in Veterans with spinal cord injury and disorders

  • B. Le
  • C. Ray
  • B. Gonzalez
  • S. Miskevics
  • F. M. Weaver
  • M. Priebe
  • L. D. CarboneEmail author
Original Article



An electronic health record (eHR) review of Veterans with a spinal cord injury and disorder (SCI/D) was conducted to understand the extent to which Veterans Affairs (VA) providers pursue workups for secondary causes of osteoporosis in this population. Laboratory tests for secondary causes were ordered in only one-third of Veterans, with secondary causes identified in two-thirds of those tested, most frequently, hypogonadism and hypovitaminosis D.


To identify workups for secondary causes of osteoporosis in SCI/D and the extent to which subspecialty consultations are sought.


A total of 3018 prescriptions for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, teriparatide) among 2675 Veterans were identified in fiscal years 2005–2015 from VA administrative databases. Approximately 10% of these prescriptions were selected for eHR review.


eHR records of 187 Veterans with a SCI/D who had received pharmacological treatment for osteoporosis were reviewed. Workups for secondary causes of osteoporosis were performed in 31.5% of Veterans (n = 59) with approximately 64.4% of those tested (n = 38) having at least one abnormality. Hypogonadism (52.0% of those tested) and hypovitaminosis D (50.0% of those tested) were the most common secondary causes of osteoporosis identified in this population. Approximately 10% of primary care and SCI providers consulted subspecialists for further evaluation and treatment of osteoporosis. Endocrinologists more frequently performed a workup for secondary causes of osteoporosis compared to other provider specialties.


Screening for secondary causes of osteoporosis, particularly for hypogonadism and hypovitaminosis D, should be considered in patients with a SCI/D.


DXA Medications Osteoporosis SCI/D 



This work was funded by the Department of Defense (DOD) Grant #SC150092.

Compliance with ethical standards

Institutional Review Board (IRB) approval for this study was obtained from the Charlie Norwood VA in Augusta, GA and the Hines VA in Chicago, IL.

Conflicts of interest



The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government.


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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Charlie Norwood Veterans Affairs Medical CenterAugustaUSA
  2. 2.Department of Medicine, Division of RheumatologyMedical College of Georgia at Augusta UniversityAugustaUSA
  3. 3.Center of Innovation for Complex Chronic HealthcareEdward J. Hines, Jr. VA HospitalHinesUSA
  4. 4.Public Health Sciences, Stritch School of MedicineLoyola UniversityMaywoodUSA
  5. 5.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  6. 6.Department of BiostatisticsUniversity of IllinoisChicagoUSA
  7. 7.Department of MathematicsNortheastern Illinois UniversityChicagoUSA
  8. 8.Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished University Chair in RheumatologyMedical College of Georgia at Augusta UniversityAugustaUSA

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