Unrecognized and unappreciated secondary causes of osteoporosis. The medical literature defines osteoporosis as either primary or secondary. There are numerous causes of secondary bone loss, including adverse effects of drug therapy, endocrine disorders. In some studies, 20% to 30% of postmenopausal women and more than 50% of men with. It may be suspected in patients who present with a fragility fracture despite having no risk factors for osteoporosis. Evaluation for secondary causes of osteoporosis and osteopenia d. From there, the two main types of osteoporosis common in adults are. Primary osteoporosis is held to be a bone disorder of relatively unknown origin that occurs with aging and accelerates at menopause. In secondary osteoporosis, additional treatment may be necessary to treat the original cause of osteoporosis. Medical conditions resulting in secondary osteoporosis may include. Secondary causes of osteoporosis should be considered in patients who suffer a fragility fracture when traditional risk factors are insufficient to explain the injury.
Some drugs that can lead to osteoporosis include corticosteroids and drugs to prevent seizures. Osteoporosis reduction in the strength of bone that leads to an. Successful early diagnosis can lead to effective treatment strategies that reduce the risk of a patients life being compromised by serious fracture injury. Osteoporosis screening, diagnosis, and treatment guideline. How to minimize the harmful effects this fact sheet may not include all medications or all medical conditions that can. The term secondary applies to patients in whom the identifiable causal factors are other than aging and menopause. Glucocorticoids are steroid medications used to treat diseases such as asthma and rheumatoid arthritis.
How to minimize the harmful effects this fact sheet may not include all medications or all medical conditions that can contribute to fractures. Tests to determine secondary causes of bone loss american. Secondary causes of osteoporosis represent the collection of heterogeneous underlying diseases and medications that may. The loss of bone may be direct or indirect but ultimately is related to altered osteoblast or osteoclast function. 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. Secondary causes occur in twothirds of males 4 and hence a more vigilant approach to detecting secondary causes of osteoporosis would be justified. Diagnosis and management of osteoporosis american family. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. Other secondary causes of osteoporosis primer on the.
She was otherwise healthy, had no notable medical history, and took no medications. This article will further address the endocrine system category. 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. 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. Secondary causes of osteoporosis mayo clinic proceedings. Up to one third of postmenopausal women, as well as many men and. Unrecognized and unappreciated secondary causes of. Some of the disease entities underlying secondary osteoporosis may be clinically silent and identified only during evaluation for documented osteoporosis. In some studies, 20% to 30% of postmenopausal women and more than 50% of men with osteoporosis have a secondary cause. Many physicians classify osteoporosis as primary type i or secondary type ii. 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.
In addition, low bmd zscores agematched comparison identify individuals requiring further evaluation for secondary causes of osteoporosis. In addition, secondary osteoporosis should be considered if the bone density zscore is 2. Approximately, more than 50% of men with osteoporosis are diagnosed with an underlying secondary cause 12, 14,26,27. The zscore is a comparison to agematched, sexmatched individuals. The focus for secondary causes of osteoporosis is separated into 5 systems. 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. Although secondary osteoporosis is less common, it is becoming more frequently diagnosed. 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. Approach to the patient with secondary osteoporosis in. This is called secondary osteoporosis sometimes, however, there is no identifiable cause of osteoporosis in a child and this is known as idiopathic osteoporosis. Secondary osteoporosis international osteoporosis foundation. The osteoporosis in men is thought to have a more underlying secondary cause than women. Secondary osteoporosis, on the other hand, is the type of osteoporosis that has a direct cause. Secondary causes sc that may lead to bone loss and their frequencies have been rarely studied among the population with osteoporosis.
Drugs and diseases that can cause bone loss, falls andor fractures. Bone is living tissue that is constantly being broken down and replaced. Primary osteoporosis is associated with the process of normal aging. Secondary causes of osteoporosis and low bone density. Secondary osteoporosis, on the other hand, is the type of osteoporosis that has. 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. Osteoporosis that results from having another disease or condition or from the treatment of another condition is called secondary osteoporosis. In some studies, 20% to 30% of postmenopausal women and. 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. Cushings disease a tumour of the pituitary gland, responsible for secreting some of the bodys hormones liver impairment. 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. 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 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. Understanding the difference between primary and secondary. Many times reversible, secondary causes of bone loss are not considered in a patient with low bone mineral density bmd. In this study, we aimed to describe the frequencies of sc in women with osteoporosis based on outpatient clinic data. For example, osteoporosis caused by the use of prednisone is a very common form of secondary osteoporosis. Underlying causes should be suspected in patients with very low bone mineral. The recommendations herein reflect an awareness of the cost and effectiveness of both diagnostic and treatment modalities. In order to prevent further loss of bone mass and fractures, it is necessary to recognize secondary osteoporosis in its early stage. This article will further address the endocrine system. Authorities state that there is no direct or singular cause for primary osteoporosis.
Secondary osteoporosis should especially be considered and extensively investigated in children, in men at all ages, and in premenopausal women with. Secondary osteoporosis is also common among patients suffering from diabetes, which can often lead to hyperglycemia or increasing levels of glycosuria. A more aggressive evaluation for secondary causes of hypertension should be considered in certain clinical situations. Primary osteoporosis is associated with the normal loss of estrogen following the menopause as well as age. Click on the image or right click to open the source website in a new browser window. Diagnosing secondary hypertension american family physician. Prevalence of causes of secondary osteoporosis and contribution to lower bone mineral density in hivinfected patients. 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. According to nih consensus conference in 2000, 3060% of osteoporosis in men is due to secondary causes.
Our work leads us to suggest that all osteoporosis is indeed caused by something, and in this sense, all osteoporosis is secondary osteoporosis. 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. 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. Secondary causes of osteoporosis can be divided into several categories. Primary osteoporosis is known as either being agerelated osteoporosis, or an unknown cause. Secondary osteoporosis is caused by certain medical conditions or treatments that interfere with the attainment of peak bone mass and may cause bone loss. Clinicians guide to prevention and treatment of osteoporosis. 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. Even the long term use of oral corticosteroids can cause hypercortisolism, which increases the chance of developing this particular type of osteoporosis. 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. Secondary causes of osteoporosis creighton school of medicine. The average older woman with normal bone density loses about % of her bone density in 10 years or about 1. 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 refers to osteoporosis in which an underlying cause or factor other than those attributable to the postmenopausal state or aging can be.
Like primary osteoporosis, secondary osteoporosis is characterized by weak bones that have lost bone density. Evaluation of secondary causes that may lead to bone loss. Secondary osteoporosis summary secondary osteoporosis is less common than primary osteoporosis. On the other hand, secondary osteoporosis develops due to several underlying factors which consist of lifestyle changes, diseases, medicines, etc. Secondary osteoporosis is caused by other health conditions. Secondary causes of osteoporosis in fracture patients. 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 causes of bone loss are not often considered in patients who are diagnosed as having osteoporosis. Osteoporosisrelated fractures most commonly occur in the hip, wrist or spine. The chart above includes a list of common conditions known to cause secondary osteoporosis.
Testing for secondary causes of osteoporosis the bmj. 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. Aug 15, 2015 secondary osteoporosis is caused by other health conditions. 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 less common than primary osteoporosis, but correctly treating an underlying cause may be sufficient to ameliorate the increased fracture risk. However, there are a number of medical conditions and medications that can cause more rapid. Second general osteoporosis, secondary generalised osteoporosis, secondary generalized osteoporosis, secondary generalized osteoporosis disorder. Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis see table 3, below. The pathogenesis of osteoporosis in these settings is typically multifactorial. 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.
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. Underlying causes should be suspected in patients with very low bone mineral density or in those without traditional risk factors for fractures. Osteoporosis is a highly prevalent, treatable disease, but it is currently incurable. 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. This type of osteoporosis is secondary to, or caused by, something else. Bone loss is a common side effect of these medications. Other connective tissue diseases include ehlerdanlos syndrome, a condition of skin and tissues having a lot of flexibility, and vitamin c deficiency. Secondary causes of osteoporosis are less common than primary osteoporosis, but. Furthermore, all individuals should follow the universal recommendations for osteoporosis prevention and management outlined in this guide.
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