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Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the Osteoporotic Fractures in Men (MrOS) Study

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An Erratum to this article was published on 20 October 2016

Abstract

Summary

We investigated the value of routine laboratory testing for identifying underlying causes in older men diagnosed with osteoporosis. Most osteoporotic and nonosteoporotic men had ≥1 laboratory abnormality. Few individual laboratory abnormalities were more common in osteoporotic men. The benefit of routine laboratory testing in older osteoporotic men may be low.

Introduction

To evaluate the utility of recommended laboratory testing to identify secondary causes in older men with osteoporosis, we examined prevalence of laboratory abnormalities in older men with and without osteoporosis.

Methods

One thousand five hundred seventy-two men aged ≥65 years in the Osteoporotic Fractures in Men study completed bone mineral density (BMD) testing and a battery of laboratory measures, including serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), 25-OH vitamin D, total testosterone, spot urine calcium/creatinine ratio, spot urine albumin/creatinine ratio, creatinine-derived estimated glomerular filtration rate, 24-h urine calcium, and 24-h urine free cortisol. Using cross-sectional analyses, we calculated prevalence ratios (PRs) and 95 % confidence intervals (CI) for the association of any and specific laboratory abnormalities with osteoporosis and the number of men with osteoporosis needed to test to identify one additional laboratory abnormality compared to testing men without osteoporosis.

Results

Approximately 60 % of men had ≥1 laboratory abnormality in both men with and without osteoporosis. Among individual tests, only vitamin D insufficiency (PR, 1.13; 95 % CI, 1.05–1.22) and high alkaline phosphatase (PR, 3.05; 95 % CI, 1.52–6.11) were more likely in men with osteoporosis. Hypercortisolism and hyperthyroidism were uncommon and not significantly more frequent in men with osteoporosis. No osteoporotic men had hypercalciuria.

Conclusions

Though most of these older men had ≥1 laboratory abnormality, few routinely recommended individual tests were more common in men with osteoporosis than in those without osteoporosis. Possibly excepting vitamin D and alkaline phosphatase, benefit of routine laboratory testing to identify possible secondary causes in older osteoporotic men appears low. Results may not be generalizable to younger men or to older men in whom history and exam findings raise clinical suspicion for a secondary cause of osteoporosis.

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Funding

The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), NIH Roadmap for Medical Research, and National Heart, Lung, and Blood Institute (NHLBI) under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, UL1 TR000128, R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, R01 HL070839, and K23HL096832. CGL receives support from a VA Clinical Science Research andDevelopment Career Development Award, Project number 5IK2CW000729-02. This material is also the result of work supported with resources and the use of facilities at the Minneapolis VA Medical Center. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the US Government. The funding agencies had no direct role in the conduct of the study; the collection, management, analyses, and interpretation of the data; or preparation or approval of the manuscript.

Conflicts of interest

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: Drs. Fink, Taylor, Schousboe, and Ensrud report grants from NIH during the conduct of the study. Dr. Schousboe also reports that he was principal investigator on a grant his employer (Park Nicollet Institute) received from Bone Ultrasound Finland Ltd. during the conduct of the study. Dr. Ensrud serves as a consultant on a Data Monitoring Committee for Merck Sharpe & Dohme. Dr. Orwoll reports grants and consulting fees from Merck & Company and Eli Lilly & Company during the conduct of the study. Dr. Lee reports a Career Development Award from VA Clinical Science Research and Development. Stephanie Litwack-Harrison, Douglas C. Bauer, Elizabeth Barrett-Connor, Deborah M. Kado, and Pranav S. Garimella declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, One Veterans Drive, 11-G, Minneapolis, MN, 55417, USA

    H. A. Fink

  2. Department of Epidemiology & Statistics, University of California, San Francisco, San Francisco Coordinating Center, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd floor, Box #0560, San Francisco, CA, USA

    S. Litwack-Harrison

  3. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Mail code 152, Building 9, Minneapolis, MN, 55417, USA

    B. C. Taylor

  4. Department of Medicine, University of California, San Francisco, 1545, Divisadero St, 3rd Floor, San Francisco, CA, USA

    D. C. Bauer

  5. Bone & Mineral Unit, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR113, Portland, OR, 97239, USA

    E. S. Orwoll

  6. Portland Veterans Affairs Health Care System, 3710 SW US Veterans Hospital Rd, R&D45, Portland, OR, 97239, USA

    C. G. Lee

  7. Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA

    E. Barrett-Connor & D. M. Kado

  8. Health Research Center, Park Nicollet Institute for Research and Education, 3800 Park Nicollet Boulevard, Minneapolis, MN, 55416, USA

    J. T. Schousboe

  9. Division of Nephrology, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA

    P. S. Garimella

  10. Division of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive, 111-0, Minneapolis, MN, 55417, USA

    K. E. Ensrud

Authors
  1. H. A. Fink
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  2. S. Litwack-Harrison
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  3. B. C. Taylor
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  4. D. C. Bauer
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  5. E. S. Orwoll
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  6. C. G. Lee
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  7. E. Barrett-Connor
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  8. J. T. Schousboe
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  9. D. M. Kado
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  10. P. S. Garimella
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  11. K. E. Ensrud
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Consortia

For the Osteoporotic Fractures in Men (MrOS) Study Group

Corresponding author

Correspondence to H. A. Fink.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00198-016-3805-2.

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Fink, H.A., Litwack-Harrison, S., Taylor, B.C. et al. Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 27, 331–338 (2016). https://doi.org/10.1007/s00198-015-3356-y

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  • DOI: https://doi.org/10.1007/s00198-015-3356-y

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