The yield of routine laboratory examination in osteoporosis evaluation in primary care.

Autor: Merlijn T; Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands. t.merlijn@merlijnenvandoorn.zorgring.nl., Swart KMA; Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands., Niemeijer C; Stichting Artsen Laboratorium en Trombosedienst, Koog Aan de Zaan, Zaanstad, The Netherlands., van der Horst HE; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands., Netelenbos CJ; Department of Internal Medicine, Endocrine Section, Amsterdam UMC, Amsterdam, The Netherlands., Elders PJM; Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2024 May; Vol. 35 (5), pp. 911-918. Date of Electronic Publication: 2024 Mar 18.
DOI: 10.1007/s00198-024-07042-3
Abstrakt: This study evaluated the yield of routine laboratory examination in a large population of older women in primary care. The prevalence of laboratory abnormalities was low and the clinical consequences in follow-up were limited. There was a weak association of laboratory abnormalities with osteoporosis but no association with vertebral fractures and recent fractures.
Purpose: Most osteoporosis guidelines advice routine laboratory examination. We have investigated the yield of laboratory examinations in facture risk evaluation of elderly women in primary care.
Methods: We assessed the prevalence of laboratory abnormalities and their association with risk factors for fractures, recent fractures, low bone mineral density (BMD), and prevalent vertebral fracture in 8996 women ≥ 65 years of age participating in a primary care fracture risk screening study. In a sample of 2208 of these participants, we also evaluated the medical consequences in the medical records during a follow-up period of ≥ 1 year.
Results: Vitamin D deficiency (< 30 nmol/L) was present in 13% and insufficiency (< 50 nmol/L) in 43% of the study sample. The prevalence of other laboratory abnormalities (ESR, calcium, creatinine, FT4) was 4.6% in women with risk factors for fractures, 6.1% in women with low BMD (T-score ≤  - 2.5), 6.0% after a prevalent vertebral fracture, 5.2% after a recent fracture and 2.6% in the absence of important risk factors for fractures. Laboratory abnormalities other than vitamin D were associated with low BMD (OR 1.4, 95%CI 1.1-1.8) but not with prevalent vertebral fractures nor recent fractures. Low BMD was associated with renal failure (OR 2.0, 95%CI 1.3-3.4), vitamin D insufficiency (OR 1.2, 95%CI 1.0-1.3) and deficiency (OR 1.3, 95%CI 1.1-.5). In the follow-up period, 82% of the laboratory abnormalities did not result in a new diagnosis or treatment reported in the medical records.
Conclusions: We identified a low prevalence of laboratory abnormalities in a primary care population of older women and the majority of these findings had no medical consequences.
(© 2024. The Author(s).)
Databáze: MEDLINE
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