PMID- 26458388 OWN - NLM STAT- MEDLINE DCOM- 20161031 LR - 20181113 IS - 1433-2965 (Electronic) IS - 0937-941X (Print) IS - 0937-941X (Linking) VI - 27 IP - 1 DP - 2016 Jan TI - Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the Osteoporotic Fractures in Men (MrOS) Study. PG - 331-8 LID - 10.1007/s00198-015-3356-y [doi] AB - We investigated the value of routine laboratory testing for identifying underlying causes in older men diagnosed with osteoporosis. Most osteoporotic and nonosteoporotic men had >/=1 laboratory abnormality. Few individual laboratory abnormalities were more common in osteoporotic men. The benefit of routine laboratory testing in older osteoporotic men may be low. INTRODUCTION: To evaluate the utility of recommended laboratory testing to identify secondary causes in older men with osteoporosis, we examined prevalence of laboratory abnormalities in older men with and without osteoporosis. METHODS: One thousand five hundred seventy-two men aged >/=65 years in the Osteoporotic Fractures in Men study completed bone mineral density (BMD) testing and a battery of laboratory measures, including serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), 25-OH vitamin D, total testosterone, spot urine calcium/creatinine ratio, spot urine albumin/creatinine ratio, creatinine-derived estimated glomerular filtration rate, 24-h urine calcium, and 24-h urine free cortisol. Using cross-sectional analyses, we calculated prevalence ratios (PRs) and 95 % confidence intervals (CI) for the association of any and specific laboratory abnormalities with osteoporosis and the number of men with osteoporosis needed to test to identify one additional laboratory abnormality compared to testing men without osteoporosis. RESULTS: Approximately 60 % of men had >/=1 laboratory abnormality in both men with and without osteoporosis. Among individual tests, only vitamin D insufficiency (PR, 1.13; 95 % CI, 1.05-1.22) and high alkaline phosphatase (PR, 3.05; 95 % CI, 1.52-6.11) were more likely in men with osteoporosis. Hypercortisolism and hyperthyroidism were uncommon and not significantly more frequent in men with osteoporosis. No osteoporotic men had hypercalciuria. CONCLUSIONS: Though most of these older men had >/=1 laboratory abnormality, few routinely recommended individual tests were more common in men with osteoporosis than in those without osteoporosis. Possibly excepting vitamin D and alkaline phosphatase, benefit of routine laboratory testing to identify possible secondary causes in older osteoporotic men appears low. Results may not be generalizable to younger men or to older men in whom history and exam findings raise clinical suspicion for a secondary cause of osteoporosis. FAU - Fink, H A AU - Fink HA AD - Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, One Veterans Drive, 11-G, Minneapolis, MN, 55417, USA. Howard.fink@va.gov. FAU - Litwack-Harrison, S AU - Litwack-Harrison S AD - Department of Epidemiology & Statistics, University of California, San Francisco, San Francisco Coordinating Center, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd floor, Box #0560, San Francisco, CA, USA. FAU - Taylor, B C AU - Taylor BC AD - Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Mail code 152, Building 9, Minneapolis, MN, 55417, USA. FAU - Bauer, D C AU - Bauer DC AD - Department of Medicine, University of California, San Francisco, 1545, Divisadero St, 3rd Floor, San Francisco, CA, USA. FAU - Orwoll, E S AU - Orwoll ES AD - Bone & Mineral Unit, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR113, Portland, OR, 97239, USA. FAU - Lee, C G AU - Lee CG AD - Portland Veterans Affairs Health Care System, 3710 SW US Veterans Hospital Rd, R&D45, Portland, OR, 97239, USA. FAU - Barrett-Connor, E AU - Barrett-Connor E AD - Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. FAU - Schousboe, J T AU - Schousboe JT AD - Health Research Center, Park Nicollet Institute for Research and Education, 3800 Park Nicollet Boulevard, Minneapolis, MN, 55416, USA. FAU - Kado, D M AU - Kado DM AD - Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. FAU - Garimella, P S AU - Garimella PS AD - Division of Nephrology, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA. FAU - Ensrud, K E AU - Ensrud KE AD - Division of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive, 111-0, Minneapolis, MN, 55417, USA. CN - Osteoporotic Fractures in Men (MrOS) Study Group LA - eng GR - R01 HL070848/HL/NHLBI NIH HHS/United States GR - R01 HL071194/HL/NHLBI NIH HHS/United States GR - R01 HL070847/HL/NHLBI NIH HHS/United States GR - K24 AR051895/AR/NIAMS NIH HHS/United States GR - UL1 TR000128/TR/NCATS NIH HHS/United States GR - R01 HL070842/HL/NHLBI NIH HHS/United States GR - U01 AG042124/AG/NIA NIH HHS/United States GR - U01 AG042145/AG/NIA NIH HHS/United States GR - U01 AG042168/AG/NIA NIH HHS/United States GR - IK2 CX000729/CX/CSRD VA/United States GR - R01 HL070841/HL/NHLBI NIH HHS/United States GR - U01 AG042140/AG/NIA NIH HHS/United States GR - R01 HL070838/HL/NHLBI NIH HHS/United States GR - R01 HL070839/HL/NHLBI NIH HHS/United States GR - U01 AG027810/AG/NIA NIH HHS/United States GR - K23HL096832/HL/NHLBI NIH HHS/United States GR - K23 HL096832/HL/NHLBI NIH HHS/United States GR - R01 HL070837/HL/NHLBI NIH HHS/United States GR - U01 AG042143/AG/NIA NIH HHS/United States GR - U01 AG042139/AG/NIA NIH HHS/United States GR - U01 AR066160/AR/NIAMS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20151012 PL - England TA - Osteoporos Int JT - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JID - 9100105 RN - 0 (Biomarkers) SB - IM EIN - Osteoporos Int. 2016 Oct 20;:. PMID: 27766366 MH - Absorptiometry, Photon/methods MH - Aged MH - Aged, 80 and over MH - Biomarkers/blood/urine MH - Bone Density/physiology MH - Cross-Sectional Studies MH - Diagnostic Tests, Routine/*methods MH - Humans MH - Male MH - Osteoporosis/*etiology/physiopathology MH - Prospective Studies MH - Unnecessary Procedures MH - Vitamin D Deficiency/complications/diagnosis PMC - PMC4719570 MID - NIHMS751346 OTO - NOTNLM OT - Aged OT - Bone mineral density OT - Male OT - Osteoporosis COIS- Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: Drs. Fink, Taylor, Schousboe and Ensrud report grants from NIH during the conduct of the study. Dr. Schousboe also reports that he was principal investigator on a grant his employer (Park Nicollet Institute) received from Bone Ultrasound Finland Ltd. during the conduct of the study. Dr. Ensrud serves as a consultant on a Data Monitoring Committee for Merck Sharpe & Dohme. Dr. Orwoll reports grants and consulting fees from Merck & Company and Eli Lilly & Company during the conduct of the study. Dr. Lee reports a Career Development Award from VA Clinical Science Research and Development. Stephanie Litwack-Harrison, Douglas C. Bauer, Elizabeth Barrett-Connor, Deborah M. Kado, and Pranav S. Garimella declare that they have no conflict of interest. EDAT- 2015/10/16 06:00 MHDA- 2016/11/01 06:00 PMCR- 2017/01/01 CRDT- 2015/10/14 06:00 PHST- 2015/09/08 00:00 [received] PHST- 2015/09/29 00:00 [accepted] PHST- 2015/10/14 06:00 [entrez] PHST- 2015/10/16 06:00 [pubmed] PHST- 2016/11/01 06:00 [medline] PHST- 2017/01/01 00:00 [pmc-release] AID - 10.1007/s00198-015-3356-y [pii] AID - 10.1007/s00198-015-3356-y [doi] PST - ppublish SO - Osteoporos Int. 2016 Jan;27(1):331-8. doi: 10.1007/s00198-015-3356-y. Epub 2015 Oct 12.