Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density
Version of Record online: 22 OCT 2002
Journal of Internal Medicine
Volume 252, Issue 5, pages 389–397, November 2002
How to Cite
Deutschmann, H. A., Weger, M., Weger, W., Kotanko, P., Deutschmann, M. J. and Skrabal, F. (2002), Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. Journal of Internal Medicine, 252: 389–397. doi: 10.1046/j.1365-2796.2002.01040.x
- Issue online: 22 OCT 2002
- Version of Record online: 22 OCT 2002
- Received 23 October 2001; revision received 17 May 2002; accepted 9 August 2002.
- bone mineral density;
- clinical guidelines;
- lactose malabsorption;
- renal tubular acidosis;
- risk factors;
- secondary osteoporosis
Abstract. Deutschmann HA, Weger M, Weger W, Kotanko P, Deutschmann MJ, Skrabal F (Krankenhaus der Barmherzigen Brüder, Marschallgasse, Teaching Hospital of the Karl-Franzens University Graz, Austria). Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J Intern Med 2002; 252: 389–397.
Objectives. To determine whether the use of more elaborate diagnostic tests can identify possible risk factors for secondary osteoporosis and to evaluate the impact of these possible risk factors on the severity of bone disease in the study population.
Design. Cross-sectional study.
Setting and participants. We have investigated 377 subjects (285 females, 92 males) with osteoporosis (T-score less than −2.5 in dual energy X-ray absorption) or nontraumatic lumbar vertebral fractures; these patients were referred to our hospital, a secondary care centre, for evaluation and treatment of osteoporosis.
Results. Osteoporosis without attributable risk factor was diagnosed in 106 women (37%) and 30 men (33%). In 241 patients (179 women, 62 men) one or more possible risk factors for osteoporosis (in this paper also called subclinical disease) were revealed. The most common were lactose malabsorption, disturbed exocrine pancreatic function and renal tubular disturbances, including renal hypercalciuria, incomplete renal tubular acidosis and mild phosphate diabetes. The number of possible risk factors in the individual patient was significantly related to the severity of osteoporosis as assessed by Z-scores (Spearman correlation r = −0.43, P < 0.001, n = 172 for females; r = −0.28, P < 0.05, n = 65 for males).
Conclusions. All the identified subclinical diseases would have remained undetected if the currently accepted guidelines for the investigation of patients with osteoporosis were applied. The statistically significant correlation between the number of identified possible risk factors and the severity of bone disease in the individual patient strongly suggests the pathogenetic significance of the identified subclinical diseases. It is yet to be shown, whether specific treatment of these subclinical diseases yields additional improvement of bone mass as compared with standard treatment of osteoporosis.