title: Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density.
abstract: OBJECTIVE
  To determine whether the use of more elaborate diagnostic tests can identify possible risk factors for secondary osteoporosis and to evaluate the impact of these possible risk factors on the severity of bone disease in the study population.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  We have investigated 377 subjects (285 females, 92 males) with osteoporosis (T-score less than -2.5 in dual energy X-ray absorption) or nontraumatic lumbar vertebral fractures; these patients were referred to our hospital, a secondary care centre, for evaluation and treatment of osteoporosis.
  
  
  RESULTS
  Osteoporosis without attributable risk factor was diagnosed in 106 women (37%) and 30 men (33%). In 241 patients (179 women, 62 men) one or more possible risk factors for osteoporosis (in this paper also called subclinical disease) were revealed. The most common were lactose malabsorption, disturbed exocrine pancreatic function and renal tubular disturbances, including renal hypercalciuria, incomplete renal tubular acidosis and mild phosphate diabetes. The number of possible risk factors in the individual patient was significantly related to the severity of osteoporosis as assessed by Z-scores (Spearman correlation r = -0.43, P < 0.001, n = 172 for females; r = -0.28, P < 0.05, n = 65 for males).
  
  
  CONCLUSIONS
  All the identified subclinical diseases would have remained undetected if the currently accepted guidelines for the investigation of patients with osteoporosis were applied. The statistically significant correlation between the number of identified possible risk factors and the severity of bone disease in the individual patient strongly suggests the pathogenetic significance of the identified subclinical diseases. It is yet to be shown, whether specific treatment of these subclinical diseases yields additional improvement of bone mass as compared with standard treatment of osteoporosis.
authors.affiliation: Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Teaching Hospital of the Karl-Franzens University Graz, Austria.
authors.forename: H A
authors.initials: HA
authors.lastname: Deutschmann
authors.forename: M
authors.initials: M
authors.lastname: Weger
authors.forename: W
authors.initials: W
authors.lastname: Weger
authors.forename: P
authors.initials: P
authors.lastname: Kotanko
authors.forename: M J
authors.initials: MJ
authors.lastname: Deutschmann
authors.forename: F
authors.initials: F
authors.lastname: Skrabal
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology; D012307:Risk Factors