title: Secondary osteoporosis: are we recognizing it?
abstract: BACKGROUND
  As a growing percentage of Americans will be reaching their elderly years in the next decade, the prevalence of osteoporosis and its effects will have an even greater impact on the healthcare system. Advancements in bone research and development of newer treatments have allowed for the establishment of more refined guidelines and a growing awareness of the need to prevent, screen, and diagnose osteoporosis. Thus, more women are now being screened with dual x-ray absorptiometry scans (DXA) than ever before. The importance of a true understanding of the test results obtained from such screening is paramount. In our institution, recommendations to consider a secondary evaluation are made by the DXA interpreters when the Z-score is low. Few, if any, studies have evaluated the rates of physician and patient adherence with specific recommendations provided on the bone density report.
  
  
  METHODS
  To assess compliance with such recommendations provided in DXA interpretations, we investigated the number of ordering providers who actually pursued these advisements.
  
  
  RESULTS
  We found that among providers ordering DXAs, primary care providers did not pursue recommendations to pursue a secondary workup as often as their subspecialty counterparts. We also found a significant amount of vitamin D deficiency/insufficiency and primary hyperparathyroidism in the population evaluated.
  
  
  CONCLUSIONS
  Primary care providers should be further educated on treatable secondary causes of osteoporosis as opposed to an often reflexive response of prescribing a pharmacological antiresportive agent without other consideration.
authors.affiliation: Women's Health Center, The Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA. sikona@ccf.org
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Sikon
authors.forename: Holly L
authors.initials: HL
authors.lastname: Thacker
authors.forename: John
authors.initials: J
authors.lastname: Carey
authors.forename: Chad
authors.initials: C
authors.lastname: Deal
authors.forename: Angelo A
authors.initials: AA
authors.lastname: Licata
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000368:Aged; D015519:Bone Density; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D017698:Postmenopause; D011315:Preventive Medicine / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D018570:Risk Assessment / Q000379:methods*; D014481:United States / Q000453:epidemiology; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration