What are the causes of secondary osteoporosis?

From the Guidelines

Secondary osteoporosis is primarily caused by medical conditions, medications, or lifestyle factors that disrupt normal bone remodeling, leading to bone loss beyond normal aging, as evident in the most recent study 1. The etiology of secondary osteoporosis is multifactorial, involving various medical conditions, medications, and lifestyle factors. Common medical causes include:

• Endocrine disorders such as hyperthyroidism, hyperparathyroidism, Cushing's syndrome, diabetes, and hypogonadism
• Gastrointestinal conditions affecting nutrient absorption, such as celiac disease and inflammatory bowel disease
• Rheumatologic diseases, including rheumatoid arthritis and ankylosing spondylitis
• Hematologic disorders, such as multiple myeloma and leukemia Medications that frequently cause secondary osteoporosis include:
• Glucocorticoids, such as prednisone and dexamethasone
• Anticonvulsants
• Aromatase inhibitors
• Androgen deprivation therapy
• Proton pump inhibitors
• Excessive thyroid hormone Lifestyle factors contributing to secondary osteoporosis include:
• Alcohol abuse
• Smoking
• Immobility
• Low body weight According to the most recent study 1, individuals with medical conditions that could alter bone mineral density (BMD), such as chronic renal failure, rheumatoid arthritis, and eating disorders, are at increased risk of developing secondary osteoporosis. Additionally, individuals receiving glucocorticoid therapy for more than three months, hypogonadal men, and those beginning or receiving long-term therapy with medications known to adversely affect BMD are also at risk. The management of secondary osteoporosis requires treating the underlying cause while implementing standard osteoporosis interventions, including calcium and vitamin D supplementation, weight-bearing exercise, and possibly bone-specific medications like bisphosphonates, depending on fracture risk assessment, as recommended in the study 1.

From the Research

Etiology of Secondary Osteoporosis

The etiology of secondary osteoporosis is complex and multifactorial. Several studies have identified various underlying causes and pathogenetic mechanisms that contribute to the development of secondary osteoporosis.

• Endocrinological causes:
  • Hypercortisolism, such as Cushing's syndrome, can lead to secondary osteoporosis due to the excessive production of cortisol, which can cause bone loss 2.
  • Hyperthyroidism can also contribute to secondary osteoporosis by increasing bone turnover and resorption 2.
  • Diabetes, particularly type 1 diabetes, has been associated with osteopenia and secondary osteoporosis 2, 3.
• Iatrogenic causes:
  • Glucocorticoid use is a common cause of secondary osteoporosis, as it can lead to bone loss and increased fracture risk 4, 2, 5.
  • Heparin therapy has also been linked to secondary osteoporosis, particularly with long-term use and high doses 2.
• Other causes:
  • Gastrointestinal disorders, such as gastrectomy, can lead to malabsorption of nutrients and secondary osteoporosis 2.
  • Immobilization, pregnancy, and lactation can also contribute to secondary osteoporosis due to changes in bone metabolism and calcium homeostasis 2, 3.
  • Alcohol abuse and certain medications, such as anticonvulsants and proton pump inhibitors, have also been associated with secondary osteoporosis 2, 3.
• Systemic diseases:
  • Chronic kidney disease can lead to secondary osteoporosis due to abnormalities in mineral and bone metabolism 4.
  • Autoimmune disorders, such as rheumatoid arthritis, can also contribute to secondary osteoporosis due to chronic inflammation and glucocorticoid use 4.

Pathophysiology and Diagnosis

The pathophysiology of secondary osteoporosis involves a complex interplay of various factors, including hormonal imbalances, nutritional deficiencies, and medication side effects. Diagnosis of secondary osteoporosis requires a comprehensive evaluation of the patient's medical history, physical examination, and laboratory tests to identify underlying causes and contributing factors 6.

• Diagnostic considerations:
  • Laboratory tests, such as bone mineral density measurements and biochemical markers of bone turnover, can help diagnose secondary osteoporosis 6.
  • Imaging studies, such as X-rays and CT scans, can also be used to evaluate bone density and detect fractures 6.
• Treatment approaches:
  • Management of secondary osteoporosis requires a tailored approach that addresses the underlying causes and contributing factors 4, 5.
  • Treatment may involve medications, such as bisphosphonates and teriparatide, as well as lifestyle modifications, such as exercise and nutrition counseling 4, 5.