What are the secondary causes of osteoporosis?

From the Guidelines

Secondary causes of osteoporosis include medications, medical conditions, and lifestyle factors that contribute to bone loss beyond the primary age-related and postmenopausal causes, and identifying these causes is crucial for improving bone health. According to the most recent evidence from 1, common medication-induced osteoporosis occurs with long-term glucocorticoid use, anticonvulsants, certain cancer treatments, excessive thyroid hormone, and aromatase inhibitors. Medical conditions that cause secondary osteoporosis include:

• Endocrine disorders (hyperthyroidism, hyperparathyroidism, Cushing's syndrome, diabetes)
• Gastrointestinal disorders affecting nutrient absorption (celiac disease, inflammatory bowel disease)
• Rheumatologic conditions (rheumatoid arthritis)
• Multiple myeloma
• Chronic kidney or liver disease Lifestyle factors such as:
• Excessive alcohol consumption
• Smoking
• Inadequate calcium and vitamin D intake
• Prolonged immobility also contribute significantly to secondary osteoporosis. Hypogonadism in both men and women represents another important cause, whether from menopause, androgen deprivation therapy, or other hormonal disorders, as noted in 1 and 1. The evidence from 1 and 1 also highlights the importance of considering medical conditions and medications that can alter bone mineral density, such as chronic renal failure, organ transplantation, and prolonged immobilization. Overall, identifying and addressing these secondary causes of osteoporosis is essential for improving bone health and reducing the risk of fractures, as emphasized in 1.

From the FDA Drug Label

Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation (i.e., decreasing absorption and increasing excretion) and inhibition of osteoblast function. This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteoporosis at any age Special consideration should be given to patients at increased risk of osteoporosis (e.g., postmenopausal women) before initiating corticosteroid therapy.

Secondary causes of osteoporosis include:

• Glucocorticoid therapy: long-term use of glucocorticoids, such as prednisone, can lead to osteoporosis 2
• Hypogonadism: reduced sex hormone production can contribute to osteoporosis 2
• Other medical conditions: certain medical conditions, such as hypothyroidism, can increase the risk of osteoporosis, although this is not directly stated in the provided drug labels, glucocorticoid therapy is a known secondary cause of osteoporosis.

From the Research

Secondary Causes of Osteoporosis

• Secondary osteoporosis occurs in almost two thirds of men, more than half of premenopausal women, and about 30% of postmenopausal women 3
• The causes of secondary osteoporosis are numerous and include:
  • Hypogonadism
  • Medications (such as corticosteroids) 4, 3, 5, 6
  • Hyperthyroidism
  • Vitamin D deficiency
  • Primary hyperparathyroidism
  • Solid organ transplantation
  • Gastrointestinal diseases
  • Hematologic diseases
  • Cushing's syndrome
  • Idiopathic hypercalciuria 3, 7, 5
• Corticosteroid-induced osteoporosis is the leading cause of secondary osteoporosis and a significant cause of morbidity in both men and women 4
• Long-term use of even low-dose corticosteroids has been associated with increased risk of bone loss 4
• Calcium and vitamin D should be recommended to patients initiating therapy with corticosteroids, and bisphosphonates are the therapy of choice for those receiving corticosteroids for greater than 3 months 4
• Other treatments for secondary osteoporosis may include hormone replacement therapy, testosterone therapy, and teriparatide (recombinant human parathyroid hormone 1-34) 4