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