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GYN: osteoporosis vs Vitamin D deficiencyFrom: art fougner, md (evsono@pipeline.com)Mon Apr 29 08:48:28 2002
this in today's ReutersHealth - Differential diagnosis recommended for suspected osteoporosis Last Updated: 2002-04-26 16:35:06 EDT (Reuters Health) NEW YORK (Reuters Health) - It is essential to complete a differential diagnosis in all patients with absorptiometric data compatible with the diagnosis of osteoporosis, according to a report in the March/April issue of Gerontology. Dual x-ray absorptiometry (DEXA) is often used to identify patients at risk for osteoporotic fractures, according to Drs. Uriel S. Barzel and Anna Freitag, from Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York. However, it does not necessarily provide the diagnostic information needed to determine the most appropriate therapeutic strategy in an individual case. In addition, several medical conditions, some occult, may cause osteoporosis, particularly in the elderly, they add. The researchers sought to "identify conditions and tests that may impact on the diagnosis and the treatment of subjects with low bone densitometry scores." They examined clinical data, history, physical examination, and laboratory tests of 272 patients with low spinal and/or femoral bone absorptiometry for potential causes of osteoporosis. Significant underlying conditions were observed in 25.3% of the patients. Forty-eight patients (17.9%) had subclinical vitamin D deficiency, "indicating an insufficient endogenous synthesis or intake of the vitamin." These patients had significant elevations in the blood parathyroid hormone levels, providing evidence that the "deficiency was physiologically significant." Hypercalciuria was observed in 17 patients (6.3%). The authors found no differences in history, symptoms, or other parameters between this group and other subjects. Another two patients (0.7%) had hyperparathyroidism. "At the minimum, blood calcium and 25-hydroxyvitamin D and 24-hour urinary calcium excretion should be examined," Drs. Barzel and Freitag recommend. "This will allow the physician to determine the appropriate course of therapy in any individual patient who has abnormal DEXA findings." Gerontology 2002;48:98-102. art
-- art fougner, md ich bin ein New Yorker
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