Who do you do a secondary/ metabolic work up on prior to treating or continuing treatment for osteopenia or osteoporosis?
n Anyone with Z score <-1.5 n Anyone with fracture history w/minimal trauma regardless of Z score. n Anyone losing bone mass >Least Significant Change by DEXA at 2-3 yrs. Discussion: When a patient has a Z score <-1.5, which means that they have a bone mineral density that is more than 1 standard deviations below normal for their age, they by definition have disproportionate osteoporosis and should have a metabolic evaluation for their osteoporosis. Anyone with history of a fracture (generally speaking, after age 50 in a low trauma situation such as from standing height or less) regardless of their Z score or T score should have a metabolic evaluation, as a fracture is the best marker of poor bone quality we have. One wrist fracture has been shown to increase a womans risk of a vertebral fracture 5 fold and a mans risk 10 fold. Remember, patients with fragility fractures have osteoporosis regardless of their T scores and often have occult vitamin D deficiency or other metabolic problem
