Purpose: We report the prevalence of vitamin D deficiency and other causes of secondary osteoporosis in a group of typical and atypical fragility fracture patients.
Method: A chart audit of 399 patients (117 males, mean age 64.6, SD 12.8; 282 females, mean age 63.5, SD 14.6) referred from an inner city orthopaedic unit to the Metabolic Bone Disease Clinic (MBDC) over a three-year period was conducted. Fracture locations and etiology: 90 hip (76 fragility), 161 wrist (135 fragility), 8 vertebral (6 fragility), 77 shoulder (62 fragility), 62 other sites (45 fragility), 1 both hip and shoulder (fragility).
Results: Thirty percent of patients (42 males, 78 females) had a total of 149 secondary causes of OP recorded. Secondary causes included medication use (oral steroids, anti-convulsants); rheumatic, gastrointestinal and endocrine conditions (RA, IBD, Graves disease, Type I DM, hyperparathyroidism); hypogonadal states (premature ovarian failure, hypogonadism); genetic conditions (hypophosphatasia); hematological conditions (thalassemia); miscellaneous causes (smoking, renal impairment). A total of 308 patients completed blood work, including 269 patients who had a 25-OH vitamin D measurement: 7 patients were deficient at ≤ 25 nmol/l, 137 were insufficient at 26 to 74 nmol/l, and 125 were sufficient at ≥ 75nmol/l. There were no differences between males and females (p = 0.457), or among fracture locations (p 0.246). Over 75% of blood/urine analyses were within the normal range for: 1,25 vitamin D, ALP, ALT, AST, bilirubin, creatinine, T3, T4, homocysteine, magnesium, phosphorus, platelets, serum calcium, protein, albumin, globulin, TSH, tissue transglutaminase, Vit B12, WBC, 24 hour urine calcium and phosphorus. Between 50 and 74% of the blood/urine analyses were within the normal range for: CRP (n = 30; 30% elevated), ESR (n = 173; 43% elevated), testosterone (n = 53; 25% of men below normal), bioavailable testosterone (n = 52; 40% of men below normal), N- telopeptide (n = 5; 30% of women elevated), RBC folate (n = 12; 33% elevated), 24 hour urine creatinine (n = 51; 27% below normal).
Conclusion: Half of the fracture patients were vitamin D insufficient. A standardized blood test protocol for all fragility fracture patients is in use.
