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Secondary Causes of Osteoporosis Higher in Fracture Patients: Presented at ASBMR

By Jill Stein
Special to DG News

SAN ANTONIO, TX -- September 23, 2002 -- Data reported at the 24^th Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) show that secondary causes of osteoporosis are present in 45.9 percent of adults who have sustained a fracture compared to 40.1 percent of non-fracture patients.

The results are from a case-control study that included men and women over the age of 50 at baseline who were enrolled in a large osteoporosis database known as CANDOO between 1990 and 1999. CANDOO is designed to prospectively compile comprehensive clinical data in multiple centers across Canada and contains data regarding patient demographics, medications and side effects, female reproductive history, diet and quality of life, bone mineral density measurements, fracture history, and laboratory investigations.

Dr. J. P. Brown, with Laval University in Ste.-Foy, Quebec, explained the rationale for the study: "The most common cause of secondary osteoporosis is corticosteroid excess, whereas others include malignancy, gastric surgery, alcoholism, and anticonvulsant therapy use. Prior studies have shown that as many as 30 percent of postmenopausal women exposed to corticosteroids demonstrate causes of secondary osteoporosis. While the prevalence of causes of secondary osteoporosis varies with the type of population and referral center, the relative difference in the prevalence of causes of secondary osteoporosis between fracture and non-fracture patients is currently unknown."

In the present study, cases were defined as persons having an osteoporotic fracture in the past five years prior to their first visit to the CANDOO site. Controls were defined as those patients who had not experienced a fracture in the past five years before their first visit.

Data were gathered for 561 men and 5604 women with a mean age of 64.1 years. Of the 1703 (28 percent) patients with a fragility fracture within five years, 151 had a hip, 539 a wrist, 741 a vertebral, and 281 a rib fracture.

25-hydroxyvitamin D levels were available in 2208 patients. Overall, 10.1 percent of fracture patients had vitamin D levels below normal ranges, while 5.6 percent of non-fracture patients had low vitamin D levels.

In addition to showing a higher rate of secondary causes of osteoporosis in fracture patients, the investigation found that causes of secondary osteoporosis (1 or more) were higher in men (288/561 or 51.3 percent) than women (2319/5604 or 41.4 percent).

Greater use of oral corticosteroids was found in men (27.1 percent) than in women (13.1 percent).

Of patients with osteoporosis, 12.8 percent had a lung disorder, 3 percent had a liver disorder, 2 percent used anticonvulsants, 0.4 percent had hyperparathyroidism, and 1.1 percent had monoclonal gammopathy.

Dr. Brown said that future research is needed to confirm the results.

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