Most providers start osteoporosis therapy without full assessment of secondary causes
Click Here to Manage Email Alerts
Key takeaways:
- A complete work-up to evaluate secondary causes of osteoporosis was done for 28.67% of postmenopausal women.
- Lack of awareness, time constraints and limited resources are possible barriers to full assessment.
NEW ORLEANS —Few providers conduct a complete assessment of secondary causes of osteoporosis before initiating medication, according to findings presented at the AACE annual meeting.
In a retrospective chart review of a small group of postmenopausal women diagnosed with osteoporosis, only 28.67% had a complete work-up for secondary causes of osteoporosis, with 24-hour urine calcium collection skipped most often.
“Globally, osteoporosis is believed to impact 200 million women. Secondary causes contributing to osteoporosis are frequently overlooked before physicians commence pharmacological treatment,” Kajol Manglani, MD, an internal medicine resident at Medstar Washington Hospital Center in Washington, D.C., told Healio. “A thorough assessment for secondary causes of osteoporosis is crucial, as it influences the selection of treatment options and modalities.”
Researchers collected electronic medical record data from 150 postmenopausal women diagnosed with osteoporosis at Medstar Washington Hospital Center who were prescribed alendronate, denosumab (Prolia, Amgen) or zoledronic acid (mean age, 64.3 years). Researchers analyzed work-up providers conducted to assess secondary causes of osteoporosis prior to the initiation of medical therapy. Based on AACE guidelines, a complete work-up for assessing secondary causes of osteoporosis should include a complete blood count, a basic metabolic panel and phosphorus, thyroid-stimulating hormone, 24-hour urine calcium, vitamin D and parathyroid hormone measurements.
An endocrinologist treated 63% of women in the study group. Of those treated by an endocrinologist, 28% had a complete work-up for secondary causes of osteoporosis. Rheumatologists conducted a complete work-up for 12% of women they treated for osteoporosis. Among women who were treated by the hospital’s fracture prevention program, 84% had a complete work-up for secondary causes of osteoporosis. The percentage of women with a complete work-up across all specialties was 28.67%.
“The primary reason for insufficient investigation often stems from a lack of awareness regarding the secondary causes of osteoporosis,” Manglani said. “Other factors, such as time constraints in busy clinical settings, limited resources and the assumption of age-related osteoporosis may contribute to this oversight. Frequently, patients are prescribed therapy before undergoing a comprehensive evaluation.”
The most skipped test among providers was 24-hour urine calcium. Conversely, vitamin D was assessed for all but 4% of women in the study.
Beginning osteoporosis treatment without investigating secondary causes could negatively impact outcomes, according to Manglani. She said bone mineral density may continue to decline if a provider does not identify the direct cause of the disease and could elevate risk for fractures.
“Interventions such as primary care physician awareness, clinical decision support systems within the electronic medical records to prompt health care providers, patient education and quality improvement initiatives are necessary to augment the rate of proper evaluation for secondary causes of osteoporosis,” Manglani said.
Collapse
Bulchandani SG, et al. Evaluation for secondary causes of osteoporosis: A retrospective review. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 9-11, 2024; New Orleans.
Click Here to Manage Email Alerts