Parathyroid/Bone Disorders
Sheetal Gopichand Bulchandani, MD
Endocrinologist
Bon Secours Southside Endocrinology
Chester, Virginia, United States
Kajol Manglani, MD (she/her/hers)
Internal Medicine Resident
Georgetown University/Washington Hospital Center
Washington, District of Columbia, United States
The primary objective of the study was to investigate the frequency with which a complete work up for secondary causes of osteoporosis is conducted before initiation of FDA-approved pharmacologic therapy.
Methods:
A retrospective chart review of post-menopausal women diagnosed with osteoporosis and treated with either alendronate, denosumab, or zoledronic acid was performed. We reviewed the electronic medical records to determine whether a workup for secondary causes of osteoporosis was done. Based on guidelines from the American Association of Clinical Endocrinologists, we considered a complete work up to include complete blood count, basic metabolic panel, phosphorus, thyroid stimulating hormone,24-hour urine calcium, Vitamin D and parathyroid hormone. Descriptive statistics were used to summarize the data and results.
Results:
A total of 150 women diagnosed and treated for osteoporosis were included in the study. The average age was 64.3 years. 63% of patients were seen by endocrinologists. 28% of patients seen by endocrinologists had a complete work-up compared to 12% of patients seen by rheumatologists versus 84% of patients seen by the head of our hospital’s fracture prevention program. Overall, only 43 women (28.67%) of patients had a complete work up performed for secondary causes of osteoporosis across all specialties. The most missed test was a 24-hour urine calcium collection. Only 4% of women did not have a Vitamin D evaluated.
Discussion/Conclusion:
An appropriate evaluation for secondary causes of osteoporosis is essential because it impacts different treatment options and modalities. We discovered low rates of complete testing for secondary causes of osteoporosis in our patient population prior to treatment initiation. Specialists were more likely to order work up than primary care physicians. Further intervention will be aimed to ensure physicians undertake adequate evaluation before considering further treatment directions.