This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tannenbaum, C. Articles by Luckey, M. Search for Related Content PubMed PubMed Citation Articles by Tannenbaum, C. Articles by Luckey, M.

Yield of Laboratory Testing to Identify Secondary Contributors to Osteoporosis in Otherwise Healthy Women

Department of Medicine (C.T., K.S.), McGill University Health Centre, and the Respiratory Epidemiology Unit (K.S.), McGill University, Montréal, Québec H3G 1A4; Departments of Biomathematical Sciences (S.W.), Community and Preventative Medicine (R.L.), Obstetrics and Gynecology (J.C., M.L.), and Geriatrics (D.M.), Mount Sinai School of Medicine, New York, New York 10029-6574; and Saint Barnabas Osteoporosis and Metabolic Bone Disease Center (M.L.), Livingston, New Jersey 07039

Address all correspondence and requests for reprints to: Marjorie Luckey, M. D., Saint Barnabas Osteoporosis and Metabolic Bone Disease Center, 200 South Orange Avenue, Livingston, New Jersey 07039. E-mail: MLuckey{at}SBHS.com.

Abstract

Our purpose in this study was to determine the prevalence of undetected disorders of bone and mineral metabolism in women with osteoporosis and to identify the most useful and cost-efficient screening tests to detect these disorders. A cross-sectional study was conducted among 664 postmenopausal women with osteoporosis at the Osteoporosis and Metabolic Bone Disease Program at the Mount Sinai Hospital in New York between January 1992 and June 1996. Women without a history of diseases or medications known to adversely affect bone who completed extensive laboratory testing including complete blood count, chemistry profile, 24-h urinary calcium, 25(OH)vitamin D, and PTH were included. Among 173 women who met the inclusion criteria for the study, previously undiagnosed disorders of bone and mineral metabolism were identified in 55 women (32%). Disorders of calcium metabolism and hyperparathyroidism were the most frequent diagnoses. A testing strategy involving measurement of 24-h urine calcium, serum calcium, and serum PTH for all women and serum TSH among women on thyroid replacement therapy would have been sufficient to diagnose 47 of these 55 women (85%) at an estimated cost of $75 per patient screened. Previously undiagnosed disorders affecting the skeleton are common in otherwise healthy women with low bone density. A simple testing strategy is likely to identify most such disorders.

This article has been cited by other articles:

				K Swaminathan, R Flynn, M Garton, C Paterson, and G Leese Search for secondary osteoporosis: are Z scores useful predictors? Postgrad. Med. J., January 1, 2009; 85(999): 38 - 39. [Abstract] [Full Text] [PDF]

				P. M. Camacho, A. S. Dayal, J. L. Diaz, F. A. Nabhan, M. Agarwal, J. G. Norton, P. A. Robinson, and K. S. Albain Prevalence of Secondary Causes of Bone Loss Among Breast Cancer Patients With Osteopenia and Osteoporosis J. Clin. Oncol., November 20, 2008; 26(33): 5380 - 5385. [Abstract] [Full Text] [PDF]

				A.E. Kearns and D.F. Kallmes Osteoporosis Primer for the Vertebroplasty Practitioner: Expanding the Focus Beyond Needles and Cement AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1816 - 1822. [Abstract] [Full Text] [PDF]

				R. C. Olney, J. M. Mazur, L. M. Pike, M. K. Froyen, G. Ramirez-Garnica, E. A. Loveless, D. M. Mandel, G. A. Hahn, K. M. Neal, and R. J. Cummings Healthy Children With Frequent Fractures: How Much Evaluation Is Needed? Pediatrics, May 1, 2008; 121(5): 890 - 897. [Abstract] [Full Text] [PDF]

				S. L. Greenspan Approach to the Prostate Cancer Patient with Bone Disease J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 2 - 7. [Abstract] [Full Text] [PDF]

				P. F. Lata and M. E. Elliott Patient Assessment in the Diagnosis, Prevention, and Treatment of Osteoporosis Nutr Clin Pract, June 1, 2007; 22(3): 261 - 275. [Abstract] [Full Text] [PDF]

				S. L. Greenspan, H. G. Bone, M. P. Ettinger, D. A. Hanley, R. Lindsay, J. R. Zanchetta, C. M. Blosch, A. L. Mathisen, S. A. Morris, T. B. Marriott, et al. Effect of Recombinant Human Parathyroid Hormone (1-84) on Vertebral Fracture and Bone Mineral Density in Postmenopausal Women with Osteoporosis: A Randomized Trial Ann Intern Med, March 6, 2007; 146(5): 326 - 339. [Abstract] [Full Text] [PDF]

				J. Blouin, A. Dragomir, L.-G. Ste-Marie, J. C. Fernandes, and S. Perreault Discontinuation of Antiresorptive Therapies: A Comparison between 1998-2001 and 2002-2004 among Osteoporotic Women J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 887 - 894. [Abstract] [Full Text] [PDF]

				K. F. Mauck and B. L. Clarke Diagnosis, Screening, Prevention, and Treatment of Osteoporosis Mayo Clin. Proc., May 1, 2006; 81(5): 662 - 672. [Abstract] [Full Text] [PDF]

				K. Templeton Secondary Osteoporosis J. Am. Acad. Ortho. Surg., November 1, 2005; 13(7): 475 - 486. [Abstract] [Full Text] [PDF]

				R. Hoyt Celiac Disease and Osteoporosis Arch Intern Med, September 12, 2005; 165(16): 1922 - 1922. [Full Text] [PDF]

				L. G. Raisz Screening for Osteoporosis N. Engl. J. Med., July 14, 2005; 353(2): 164 - 171. [Full Text] [PDF]

				M. J. Favus Postmenopausal Osteoporosis and the Detection of So-Called Secondary Causes of Low Bone Density J. Clin. Endocrinol. Metab., June 1, 2005; 90(6): 3800 - 3801. [Full Text] [PDF]

				A A Fisher, M W Davis, and M M Budge Should we screen adults with osteoporotic fractures for coeliac disease? Gut, January 1, 2004; 53(1): 154 - 155. [Full Text]

				U. Turpeinen, U. Hohenthal, and U.-H. Stenman Determination of 25-Hydroxyvitamin D in Serum by HPLC and Immunoassay Clin. Chem., September 1, 2003; 49(9): 1521 - 1524. [Full Text] [PDF]

				J.-C. Souberbielle, E. Lawson-Body, B. Hammadi, E. Sarfati, A. Kahan, and C. Cormier The Use in Clinical Practice of Parathyroid Hormone Normative Values Established in Vitamin D-Sufficient Subjects J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3501 - 3504. [Abstract] [Full Text] [PDF]

				M. M. Luckey and C. Tannenbaum Authors' Response: Recommended Testing in Patients with Low Bone Density J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1405 - 1405. [Full Text]

				U. S. Barzel Recommended Testing in Patients with Low Bone Density J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1404 - 1405. [Full Text]

				R. B. Wagman and R. Marcus Beyond Bone Mineral Density--Navigating the Laboratory Assessment of Patients with Osteoporosis J. Clin. Endocrinol. Metab., October 1, 2002; 87(10): 4429 - 4430. [Full Text] [PDF]