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. She was otherwise healthy, had no notable medical history, and took no medications. Identification and treatment of osteoporosis in the fragility fracture population and interventions to reduce the risk of future fracture are improving in orthopaedic practice. Approximately, more than 50% of men with osteoporosis are diagnosed with an underlying secondary cause 12, 14,26,27. Up to one third of postmenopausal women, as well as many men and. This article will further address the endocrine system. Unrecognized and unappreciated secondary causes of osteoporosis. In some studies, 20% to 30% of postmenopausal women and. Evaluation for secondary causes of osteoporosis and osteopenia d. Many physicians classify osteoporosis as primary type i or secondary type ii. 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. In this study, we aimed to describe the frequencies of sc in women with osteoporosis based on outpatient clinic data.
The recommendations herein reflect an awareness of the cost and effectiveness of both diagnostic and treatment modalities. In addition, low bmd zscores agematched comparison identify individuals requiring further evaluation for secondary causes of osteoporosis. Secondary osteoporosis is caused by other health conditions. Successful early diagnosis can lead to effective treatment strategies that reduce the risk of a patients life being compromised by serious fracture injury. Although secondary osteoporosis is less common, it is becoming more frequently diagnosed. Other secondary causes of osteoporosis primer on the.
Underlying causes should be suspected in patients with very low bone mineral. Drugs and diseases that can cause bone loss, falls andor fractures. 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. Osteoporosisrelated fractures most commonly occur in the hip, wrist or spine. Unrecognized and unappreciated secondary causes of. Approach to the patient with secondary osteoporosis in. Some drugs that can lead to osteoporosis include corticosteroids and drugs to prevent seizures. In order to prevent further loss of bone mass and fractures, it is necessary to recognize secondary osteoporosis in its early stage. Glucocorticoids are steroid medications used to treat diseases such as asthma and rheumatoid arthritis.
Diagnosing secondary hypertension american family physician. 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. 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. According to nih consensus conference in 2000, 3060% of osteoporosis in men is due to secondary causes. 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. These images are a random sampling from a bing search on the term osteoporosis secondary causes.
Clinicians guide to prevention and treatment of osteoporosis. How to minimize the harmful effects this fact sheet may not include all medications or all medical conditions that can contribute to fractures. Primary osteoporosis is known as either being agerelated osteoporosis, or an unknown cause. Even the long term use of oral corticosteroids can cause hypercortisolism, which increases the chance of developing this particular type of osteoporosis. Secondary causes occur in twothirds of males 4 and hence a more vigilant approach to detecting secondary causes of osteoporosis would be justified. Secondary osteoporosis low bone mineral density or increased risk of fragility fracture caused by any factor other than aging or postmenopausal status miller pd. Secondary osteoporosis summary secondary osteoporosis is less common than primary 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. Secondary causes of osteoporosis should be considered in patients who suffer a fragility fracture when traditional risk factors are insufficient to explain the injury. Cushings disease a tumour of the pituitary gland, responsible for secreting some of the bodys hormones liver impairment.
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. Primary osteoporosis is associated with the normal loss of estrogen following the menopause as well as age. In some studies, 20% to 30% of postmenopausal women and more than 50% of men with osteoporosis have a secondary cause. The term secondary applies to patients in whom the identifiable causal factors are other than aging and menopause. Underlying causes should be suspected in patients with very low bone mineral density or in those without traditional risk factors for fractures. A more aggressive evaluation for secondary causes of hypertension should be considered in certain clinical situations. 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 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. Authorities state that there is no direct or singular cause for primary osteoporosis. 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.
Second general osteoporosis, secondary generalised osteoporosis, secondary generalized osteoporosis, secondary generalized osteoporosis disorder. 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. Understanding the difference between primary and secondary. This type of osteoporosis is secondary to, or caused by, something else. Diagnosis and management of osteoporosis american family. 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. Primary osteoporosis is associated with the process of normal aging. Some of the disease entities underlying secondary osteoporosis may be clinically silent and identified only during evaluation for documented osteoporosis. Secondary osteoporosis international osteoporosis foundation. Estrogen and progesterone are two hormones that play important roles in regulating the rate at which bone is lost. Furthermore, all individuals should follow the universal recommendations for osteoporosis prevention and management outlined in this guide. This article will further address the endocrine system category. Other connective tissue diseases include ehlerdanlos syndrome, a condition of skin and tissues having a lot of flexibility, and vitamin c deficiency.
Osteoporosis that results from having another disease or condition or from the treatment of another condition is called secondary osteoporosis. Secondary osteoporosis should especially be considered and extensively investigated in children, in men at all ages, and in premenopausal women with. Bone is living tissue that is constantly being broken down and replaced. 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. From there, the two main types of osteoporosis common in adults are. The osteoporosis in men is thought to have a more underlying secondary cause than women. The pathogenesis of osteoporosis in these settings is typically multifactorial. Testing for secondary causes of osteoporosis the bmj. Themost common of these risk factors are age and female sex. 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. The average older woman with normal bone density loses about % of her bone density in 10 years or about 1. Tests to determine secondary causes of bone loss american. Medical conditions resulting in secondary osteoporosis may include.
Prevalence of causes of secondary osteoporosis and contribution to lower bone mineral density in hivinfected patients. Many times reversible, secondary causes of bone loss are not considered in a patient with low bone mineral density bmd. The focus for secondary causes of osteoporosis is separated into 5 systems. Evaluation of secondary causes that may lead to bone loss. Secondary causes of osteoporosis creighton school of medicine. Secondary osteoporosis is also common among patients suffering from diabetes, which can often lead to hyperglycemia or increasing levels of glycosuria. Secondary causes of osteoporosis represent the collection of heterogeneous underlying diseases and medications that may. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. Patients who have undergone organ transplantation are also at increased risk for 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. There are numerous causes of secondary bone loss, including adverse effects of drug therapy, endocrine disorders. The zscore is a comparison to agematched, sexmatched individuals. 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.
Secondary causes of osteoporosis in fracture patients. Osteoporosis is a highly prevalent, treatable disease, but it is currently incurable. 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 can be divided into several categories. 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. Secondary causes of osteoporosis and low bone density. In secondary osteoporosis, additional treatment may be necessary to treat the original cause of osteoporosis. 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 refers to osteoporosis in which an underlying cause or factor other than those attributable to the postmenopausal state or aging can be. The chart above includes a list of common conditions known to cause secondary osteoporosis.
However, there are a number of medical conditions and medications that can cause more rapid. 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. 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 osteoporosis, on the other hand, is the type of osteoporosis that has. Secondary causes of osteoporosis are less common than primary osteoporosis, but. In addition, secondary osteoporosis should be considered if the bone density zscore is 2. On the other hand, secondary osteoporosis develops due to several underlying factors which consist of lifestyle changes, diseases, medicines, etc. Primary osteoporosis is held to be a bone disorder of relatively unknown origin that occurs with aging and accelerates at menopause. Secondary causes of bone loss are not often considered in patients who are diagnosed as having osteoporosis. 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. Secondary causes of osteoporosis mayo clinic proceedings. The medical literature defines osteoporosis as either primary or secondary.
For example, osteoporosis caused by the use of prednisone is a very common form of secondary osteoporosis. Bone loss is a common side effect of these medications. How to minimize the harmful effects this fact sheet may not include all medications or all medical conditions that can. Click on the image or right click to open the source website in a new browser window. 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. Secondary osteoporosis, on the other hand, is the type of osteoporosis that has a direct cause. Osteoporosis reduction in the strength of bone that leads to an.
Like primary osteoporosis, secondary osteoporosis is characterized by weak bones that have lost bone density. This is called secondary osteoporosis sometimes, however, there is no identifiable cause of osteoporosis in a child and this is known as idiopathic osteoporosis. 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. Secondary causes sc that may lead to bone loss and their frequencies have been rarely studied among the population with osteoporosis. Our work leads us to suggest that all osteoporosis is indeed caused by something, and in this sense, all osteoporosis is secondary osteoporosis. The loss of bone may be direct or indirect but ultimately is related to altered osteoblast or osteoclast function. Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis see table 3, below. Secondary osteoporosis hormonal causes treatment 4.
1004 275 920 379 524 1536 923 1502 1395 147 702 956 417 80 293 1445 4 1016 1270 648 110 1366 1303 1009 786 1379 1036 1539 1377 1131 855 587 319 1112 390 329 404 385 957 1078 960 921 718 686 966 19 559 1117