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The Value of a Complete Medical Evaluation

Bruce E. Johnson, MD; Beth Lucasey, RN; Ralph G. Robinson, MD; Barbara P. Lukert, MD

Arch Intern Med. 1989;149(5):1069-1072.

Abstract
• Osteoporosis often occurs as a consequence of, or is accelerated by, many medical diseases, drug exposures, or other conditions. We called these conditions contributing diagnoses. Although technological advances permit the accurate measurement of bone density, identifying osteoporosis without searching for contributing diagnoses may result in remediable diseases being missed or in the initiation of inadvisable therapy. The value of comprehensive medical evaluation in conjunction with appropriate diagnostic studies was demonstrated in an osteoporosis referral center. We studied 300 consecutive persons who presented to an osteoporosis clinic. Using strict criteria, 180 patients (60%) had osteoporosis. Of these 180 patients, 83 (46%) had one or more contributing diagnosis, ie, a condition thought to accelerate bone loss. The largest single group was composed of persons with past or present exposure to glucocorticoids; the second largest group consisted of women who had undergone premature menopause. In all, 27 different contributing diagnoses were identified. Additionally, in 19(11%) of the 180 patients with osteoporosis, a contributing diagnosis new to those patients was made. The evaluation of osteoporosis does not only entail measurement of bone density but must also take into consideration a patient's entire medical milieu.

(Arch Intern Med. 1989;149:1069-1072)

Author Affiliations
From the Departments of Medicine (Drs Johnson and Lukert and Ms Lucasey) and Diagnostic Radiology (Nuclear Medicine) (Dr Robinson), University of Kansas Medical Center, Kansas City.

Footnotes
Accepted for publication December 28, 1988.

Reprint requests to Department of Medicine, University of Kansas Medical Center, 39th Street and Rainbow Boulevard, Kansas City, KS 66103 (Dr Johnson).

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