Dr Field correctly points out that managing osteoporosis in elderly patients with hip fracture with low serum vitamin D levels, hypogonadism, or secondary hyperparathyroidism may require the expertise of an endocrinologist. In fact, there are many other causes of low bone mineral density (BMD), including various endocrinopathies and drugs, malabsorption syndromes, marrow-based and neoplastic disorders, inherited diseases, and osteomalacia. Patients should not commence antiresorptive treatment until secondary causes of low BMD have been ruled out or addressed. But, not all cases of postmenopausal osteoporosis are complicated, and the cause of accurately measured low BMD is not always difficult to determine. Physicians in many different specialties can learn to effectively manage postmenopausal osteoporosis and low BMD in premenopausal women and men. And that is a good thing because there are not enough endocrinologists in the United States to manage all patients with osteoporosis or low BMD.
Kiebzak GM. Fractures, Osteoporosis, and the Endocrinologist—Reply. Arch Intern Med. 2003;163(22):2796–2797. doi:10.1001/archinte.163.22.2796-a
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