Secondary causes of osteoporosis can be divided into several categories. A more aggressive evaluation for secondary causes of hypertension should be considered in certain clinical situations. Our work leads us to suggest that all osteoporosis is indeed caused by something, and in this sense, all osteoporosis is secondary osteoporosis. On the other hand, secondary osteoporosis develops due to several underlying factors which consist of lifestyle changes, diseases, medicines, etc. Evaluation of secondary causes that may lead to bone loss.
Primary osteoporosis is associated with the normal loss of estrogen following the menopause as well as age. Secondary osteoporosis summary secondary osteoporosis is less common than primary osteoporosis. Primary osteoporosis is held to be a bone disorder of relatively unknown origin that occurs with aging and accelerates at menopause. Secondary osteoporosis is caused by other health conditions. This may be due to the medications direct effect on bone, muscle weakness or immobility, reduced intestinal absorption of calcium, a decrease in testosterone levels, or, most likely, a combination of these factors. Secondary causes of osteoporosis and low bone density. Early diagnosis and quantification of bone loss and fracture risk are important because of the availability of therapies that can slow or even reverse the progression of osteoporosis. Men and women of any age with conditions known to be secondary causes of osteoporosis no every 210 years depending on initial tscore see p. This article will further address the endocrine system category. Understanding the difference between primary and secondary.
Primary osteoporosis is known as either being agerelated osteoporosis, or an unknown cause. Aug 15, 2015 secondary osteoporosis is caused by other health conditions. Some of the disease entities underlying secondary osteoporosis may be clinically silent and identified only during evaluation for documented osteoporosis. Secondary causes of osteoporosis are less common than primary osteoporosis, but correctly treating an underlying cause may be sufficient to ameliorate the increased fracture risk. Identification and treatment of osteoporosis in the fragility fracture population and interventions to reduce the risk of future fracture are improving in orthopaedic practice.
Secondary causes of osteoporosis are very common, particularly in premenopausal women and in men with osteoporosis, while also being the cause of accelerated bone loss in postmenopausal and age. How to minimize the harmful effects this fact sheet may not include all medications or all medical conditions that can contribute to fractures. In order to prevent further loss of bone mass and fractures, it is necessary to recognize secondary osteoporosis in its early stage. Osteoporosis causes bones to become weak and brittle so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. The average older woman with normal bone density loses about % of her bone density in 10 years or about 1.
Secondary osteoporosis is also common among patients suffering from diabetes, which can often lead to hyperglycemia or increasing levels of glycosuria. She was otherwise healthy, had no notable medical history, and took no medications. Jun 01, 2016 secondary causes of osteoporosis are less common than primary osteoporosis, but correctly treating an underlying cause may be sufficient to ameliorate the increased fracture risk. Secondary osteoporosis low bone mineral density or increased risk of fragility fracture caused by any factor other than aging or postmenopausal status miller pd. Underlying causes should be suspected in patients with very low bone mineral density or in those without traditional risk factors for fractures. The focus for secondary causes of osteoporosis is separated into 5 systems. The chart above includes a list of common conditions known to cause secondary osteoporosis. Secondary causes sc that may lead to bone loss and their frequencies have been rarely studied among the population with osteoporosis. Tests to determine secondary causes of bone loss american.
Hypogonadism is the most common cause of osteoporosis in men and is present in up to 20% of men with symptomatic vertebral fractures and 50% of elderly. Secondary osteoporosis drugs and diseases that can cause bone loss, falls andor fractures t here are several well known risk factors for osteoporosis and osteoporotic fractures such as age, sex, low body weight, a low bone mineral density, a past fragility fracture, having a parent who had a hip fracture and a past history of falls. A total of 98 patients 32% had 125 secondary causes of osteoporosis other than vitamin d deficiency or insufficiency recorded in their electronic chart, including medication use, premature ovarian failure, hypogonadism, smoking, excessive alcohol use, renal impairment, gastrointestinal conditions, and endocrine conditions. Furthermore, all individuals should follow the universal recommendations for osteoporosis prevention and management outlined in this guide. These images are a random sampling from a bing search on the term osteoporosis secondary causes. Secondary osteoporosis, on the other hand, is the type of osteoporosis that has a direct cause. Estrogen and progesterone are two hormones that play important roles in regulating the rate at which bone is lost. Secondary osteoporosis refers to osteoporosis in which an underlying cause or factor other than those attributable to the postmenopausal state or aging can be. The loss of bone may be direct or indirect but ultimately is related to altered osteoblast or osteoclast function. Secondary osteoporosis, on the other hand, is the type of osteoporosis that has. Secondary osteoporosis should especially be considered and extensively investigated in children, in men at all ages, and in premenopausal women with. Although idiopathic osteoporosis is the most common form of osteoporosis, secondary factors may contribute to the bone loss and increased fracture risk in patients presenting with fragility fractures or osteoporosis. In some studies, 20% to 30% of postmenopausal women and more than 50% of men with osteoporosis have a secondary cause. In this study, we aimed to describe the frequencies of sc in women with osteoporosis based on outpatient clinic data.
This type of osteoporosis is secondary to, or caused by, something else. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. Secondary causes of osteoporosis are less common than primary osteoporosis, but. This article will further address the endocrine system. Other secondary causes of osteoporosis primer on the. In addition, secondary osteoporosis should be considered if the bone density zscore is 2. Authorities state that there is no direct or singular cause for primary osteoporosis.
Approach to the patient with secondary osteoporosis in. In some studies, 20% to 30% of postmenopausal women and. Secondary osteoporosis international osteoporosis foundation. Even the long term use of oral corticosteroids can cause hypercortisolism, which increases the chance of developing this particular type of osteoporosis. According to nih consensus conference in 2000, 3060% of osteoporosis in men is due to secondary causes. The zscore is a comparison to agematched, sexmatched individuals. Jul 11, 2014 in many years of researching bone health, however, we at the center for better bones have come to challenge this distinction between primary and secondary osteoporosis. Osteogenesis imperfecta ostehjenisis imperfekte is a disorder that causes secondary osteoporosis due to a high level of calcium, the same as hyperparathyroidism, as discussed above. Osteoporosis reduction in the strength of bone that leads to an. For example, osteoporosis caused by the use of prednisone is a very common form of secondary osteoporosis. Up to one third of postmenopausal women, as well as many men and premenopausal women, have a coexisting cause of bone loss, 43, 44 of which renal hypercalciuria is one.
In secondary osteoporosis, additional treatment may be necessary to treat the original cause of osteoporosis. Secondary causes of bone loss are not often considered in patients who are diagnosed as having osteoporosis. Secondary causes of osteoporosis should be considered in patients who suffer a fragility fracture when traditional risk factors are insufficient to explain the injury. Approximately, more than 50% of men with osteoporosis are diagnosed with an underlying secondary cause 12, 14,26,27. There are numerous causes of secondary bone loss, including adverse effects of drug therapy, endocrine disorders. Apart from the welldefined risk of secondary osteoporosis in patients requiring longterm corticosteroids therapy, an increasing list of dietary, lifestyle, endocrine, metabolic, and other causes of bone mass deterioration has been identified table 1. Cushings disease a tumour of the pituitary gland, responsible for secreting some of the bodys hormones liver impairment. Evaluation for secondary causes of osteoporosis and osteopenia d. Osteoporosis screening, diagnosis, and treatment guideline. The osteoporosis in men is thought to have a more underlying secondary cause than women. Patients who have undergone organ transplantation are also at increased risk for osteoporosis. Primary osteoporosis is associated with the process of normal aging.
Successful early diagnosis can lead to effective treatment strategies that reduce the risk of a patients life being compromised by serious fracture injury. Themost common of these risk factors are age and female sex. The term secondary applies to patients in whom the identifiable causal factors are other than aging and menopause. The pathogenesis of osteoporosis in these settings is typically multifactorial. Feb 27, 2019 this is called secondary osteoporosis sometimes, however, there is no identifiable cause of osteoporosis in a child and this is known as idiopathic osteoporosis. Bone is living tissue that is constantly being broken down and replaced. This is called secondary osteoporosis sometimes, however, there is no identifiable cause of osteoporosis in a child and this is known as idiopathic osteoporosis. Unrecognized and unappreciated secondary causes of. It may be suspected in patients who present with a fragility fracture despite having no risk factors for osteoporosis. Osteoporosisrelated fractures most commonly occur in the hip, wrist or spine.
Many times reversible, secondary causes of bone loss are not considered in a patient with low bone mineral density bmd. Glucocorticoids are steroid medications used to treat diseases such as asthma and rheumatoid arthritis. Although secondary osteoporosis is less common, it is becoming more frequently diagnosed. Unrecognized and unappreciated secondary causes of osteoporosis. Some drugs that can lead to osteoporosis include corticosteroids and drugs to prevent seizures.
Secondary causes of osteoporosis represent the collection of heterogeneous underlying diseases and medications that may. Diagnosis and management of osteoporosis american family. Prevalence of causes of secondary osteoporosis and contribution to lower bone mineral density in hivinfected patients. In addition, low bmd zscores agematched comparison identify individuals requiring further evaluation for secondary causes of osteoporosis. Drugs and diseases that can cause bone loss, falls andor fractures. However, the 22% of patients who were diagnosed as having primary osteoporosis included 8 of the 18 patients with hypercalciuria, the reason for which was not clear.
Druginduced osteoporosis 204 psapvii womens and mens health risk factors among the most important strategies in managing druginduced osteoporosis is awareness of other factors than can affectbone health and fracture risk box 11. Up to one third of postmenopausal women, as well as many men and. In a separate study 3 in an outpatient rheumatology department, causes of osteoporosis in 81 osteoporotic men were evaluated, and 63 men 78% had secondary osteoporosis. Like primary osteoporosis, secondary osteoporosis is characterized by weak bones that have lost bone density. Osteoporosis is a highly prevalent, treatable disease, but it is currently incurable. Secondary causes of osteoporosis mayo clinic proceedings. Secondary osteoporosis hormonal causes treatment 4. Underlying causes should be suspected in patients with very low bone mineral. In some studies, 20% to 30% of postmenopausal women and more than 50% of men with. This study investigated the prevalence of vitamin d insufficiency and deficiency and other secondary causes of low bone density in patients who have sustained a fragility fracture and were referred from. Osteoporosis that results from having another disease or condition or from the treatment of another condition is called secondary osteoporosis.
With secondary osteoporosis, an increased rate of bone remodeling or an increase in the amount of bone being remodeled causes an overall increase in the rate of bone loss. The recommendations herein reflect an awareness of the cost and effectiveness of both diagnostic and treatment modalities. Clinicians guide to prevention and treatment of osteoporosis. Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis see table 3, below. Secondary causes of osteoporosis creighton school of medicine. The medical literature defines osteoporosis as either primary or secondary. Many physicians classify osteoporosis as primary type i or secondary type ii.
Secondary causes of osteoporosis osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine, and wrist. Diagnosing secondary hypertension american family physician. Second general osteoporosis, secondary generalised osteoporosis, secondary generalized osteoporosis, secondary generalized osteoporosis disorder. From there, the two main types of osteoporosis common in adults are. Testing for secondary causes of osteoporosis the bmj. How to minimize the harmful effects this fact sheet may not include all medications or all medical conditions that can. Bone loss is a common side effect of these medications. Secondary causes of osteoporosis in fracture patients. Click on the image or right click to open the source website in a new browser window. The asbmr secondary fracture prevention initiative brings together a global coalition of top bone health experts and representatives of a broad range of health care professional organizations and patient advocacy organizations dedicated to reducing the number of avoidable second fractures in individuals with osteoporosis. There are numerous causes of secondary bone loss, including adverse effects of drug therapy, endocrine disorders, eating disorders, immobilization, marrowrelated disorders, disorders of the gastrointestinal or biliary tract, renal disease, and cancer. Secondary osteoporosis is caused by certain medical conditions or treatments that interfere with the attainment of peak bone mass and may cause bone loss. Secondary causes occur in twothirds of males 4 and hence a more vigilant approach to detecting secondary causes of osteoporosis would be justified. However, there are a number of medical conditions and medications that can cause more rapid.
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