Secondary causes of bone loss often missed: ob.gyns., other primary care doctors less likely to follow up on problematic scans.(Gynecology)

WASHINGTON -- Primary care physicians are less likely than specialists to initiate a work-up for secondary causes of bone loss in patients with scans indicating low bone density, despite a recommendation to do so.

That finding emerged from a study presented in poster form during the annual meeting of the North American Menopause Society.

Some patients with scans indicating osteoporosis were premenopausal women who started treatment with a bisphosphonate after their physicians received the scan results. Eventually, however, these patients were diagnosed with vitamin D deficiency, according to Andrea Sikon, M.D., of the Cleveland Clinic Women's Health Center, and her associates.

The study involved a review of 1,114 consecutive dual energy x-ray absorptiometry (DXA) scans performed at the center from July 2002 to August 2003. Of these scans, 712 (64%) were considered indicative of osteopenia (a T score ranging from -1.1 to -2.4), or of osteoporosis (a T score of -2.5 or below), according to World Health Organization criteria.

An evaluation for secondary causes of low bone density was recommended by the interpreter reading the scans in 77 of the 712 women with z scores equal to or less than -1.5.

These 77 women were aged 27-84 years, with a mean of 53 years.

But only 49 (64%) of the 77 women actually had a secondary evaluation as recommended, and laboratory tests were drawn only in 42 (55%) of these women.