Bone loss occurs during the normal aging process. The term “primary” osteoporosis
refers to osteoporosis that results from the involutional losses associated with aging
and, in women, additional losses related to natural menopause. Osteoporosis that is
caused or exacerbated by other disorders or medication exposures is referred to as
“secondary” osteoporosis [
1
,
2
,
3
]. The prevalence of secondary causes of osteoporosis varies according to the population
studied. Secondary causes are most commonly found in pre-menopausal women and in men
with osteoporosis, with the reported prevalence among men as high as 64% [
[4]
]. Secondary causes are not limited to these groups, however. As many as 30% of postmenopausal
women with osteoporosis have been found to have other conditions that may have contributed
to their bone loss [
[3]
]. There are many causes of secondary osteoporosis (Box 1), including hypogonadism, endocrine disorders, gastrointestinal (GI) diseases, transplantation,
genetic disorders, and medications [
[5]
]. This article describes the major etiologies and provides a framework for the diagnostic
investigation of patients suspected of having secondary osteoporosis.
Box 1
Secondary causes of osteoporosis
-
Ehlers-Danlos
-
Glycogen storage diseases
-
Gaucher disease
-
Hemochromatosis
-
Homocystinuria
-
Hypophosphatasia
-
Marfan syndrome
-
Menkes steely hair syndrome
-
Osteogenesis imperfecta
-
Porphyria
-
Riley-Day syndrome
-
Hypogonadal states
Genetic disorders
-
Androgen insensitivity
-
Anorexia nervosa/bulemia
-
Athletic amenorrhea
-
Hyperprolactinemia
-
Panhypopituitarism
-
Premature menopause
-
Turner and Kleinfelter syndromes
Hypogonadal states
-
Acromegaly
-
Adrenal insufficiency
-
Cushing syndrome
-
Diabetes mellitus
-
Hyperparathyroidism (1° and 2°)
-
Thyroid disease
Endocrine disorders
-
Gastrectomy
-
Inflammatory bowel disease
-
Malabsorption
-
Celiac disease
-
Primary biliary cirrhosis
Gastrointestinal diseases
-
Sickle cell disease
-
Thalassemia
-
Hemophilia
-
Multiple myeloma
-
Leukemias and lymphomas
-
Systemic mastocytosis
Hematologic disorders
-
Ankylosing spondylitis
-
Rheumatoid arthritis
Rheumatologic diseases
-
Calcium
-
Magnesium
-
Vitamin D
Nutritional deficiencies
-
Anticoagulants (heparin and warfarin)
-
Anticonvulsants
-
Cyclosporines and tacrolimus
-
Cytotoxic drugs
-
Glucocorticoids (and adrenocorticotropic hormone)
-
Gonadotropin-releasing hormone agonists
-
Methotrexate
-
Thyroxine
Drugs
-
Alcoholism
-
Amyloidosis
-
Chronic metabolic acidosis
-
Congestive heart failure
-
Cystic fibrosis
-
Emphysema
-
End stage renal disease
-
Idiopathic hypercalciuria
-
Idiopathic scoliosis
-
Immobilization
-
Multiple sclerosis
-
Organ transplantation
-
Parenteral nutrition
-
Sarcoidosis
Miscellaneous
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References
- Osteoporosis.in: Manolagas S.C Olefsky J.M Metabolic bone and mineral disorders. Churchill Livingstone, New York1988: 151-192
- Osteoporosis secondary to illnesses and medications.in: Marcus R Feldman D Kelsey J Osteoporosis. Academic Press, San Diego2001: 303-327
- Causes of secondary osteoporosis.J Clin Densitom. 1999; 2: 79-92
- Secondary osteoporosis: diagnostic considerations.Endocrinol Metab Clin North Am. 1998; 27: 325-348
- Secondary osteoporosis.in: Seibel M.J Robins S.P Bilezikian J.P Dynamics of bone and cartilage metabolism. Academic Press, San Diego1999: 527-546
- Osteoporosis in Turner's syndrome and other forms of primary amenorrhea.Clin Endocrinol (Oxf). 1995; 43: 741-746
- Amennorheic bone loss.Clin Endocrinol Metab. 1999; 84: 1775-1783
- Bone density of women who have recovered from anorexia nervosa.Int J Eat Disord. 2000; 28: 107-112
- Implications of not treating hyperprolactinemia.J Reprod Med. 1999; 44: 1111-1115
- Plasma levels of parathyroid hormone-related peptide are elevated in hyperprolactinemia and are correlated to bone density status.J Bone Miner Res. 1995; 10: 751-759
- Osteoporosis and Klinefelter's Syndrome.Clin Endocrinol (Oxf). 1992; 36: 113-118
- The contribution of testosterone to skeletal development and maintenance: lessons from the androgen insensitivity syndrome.J Clin Endocrinol Metab. 2000; 85: 1032-1037
- Secondary causes of osteoporosis: thyrotoxicosis and weight bearing.in: Favus M.J Primer on the metabolic bone diseases and disorders of mineral metabolism. Lippincott Williams and Wilkins, Philadelphia1999: 305-307
- Bone loss in hyperthyroid patients and in former hyperthyroid patients controlled on medical therapy: influence of aetiology and menopause.Clin Endocrinol (Oxf). 1997; 47: 279-285
- Diabetes mellitus a risk for osteoporosis?.Exp Clin Endocrinol Diabetes. 2001; 109: S493-S514
- The change of bone mineral density in secondary osteoporosis and vertebral fracture incidence.J Bone Miner Metab. 1999; 17: 119-124
- Osteoporosis in hemochromatosis: Iron excess, gonadal deficiency, or other factors?.Ann Intern Med. 1989; 110: 430-436
- Is dehydroepiandrostenedione sulfate a possible pathogenic factor in osteopenia of patients with genetic iron overload?.Haemotologia. 1991; 24: 47-56
- Bone and joint involvement in genetic hemochromatosisrole of cirrhosis and iron overload.J Rheumatol. 1997; 24: 1809-1813
- Differential actions of endocrine dysfunction on the axial and appendicular skeleton.J Clin Invest. 1982; 69: 1302-1309
- Bone mineral density in acromegaly: does growth hormone excess protect against osteoporosis?.J Endocrinol Invest. 2001; 24: 288-291
- Bone disease in primary hyperparathyroidism.Endocrinol Metab Clin North Am. 1990; 19: 19-34
- The mechanism of cancellous bone preservation in postmenopausal women with mild primary hyperparathyroidism.J Clin Endocrinol Metab. 1999; 84: 1562-1566
- Bone structure in postmenopausal hyperparathyroid, osteoporotic, and normal women.J Bone Miner Res. 1995; 10: 1393-1399
- Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism.BMJ. 2000; 321: 598-602
- Osteoporosis in gastrointestinal, pancreatic, and hepatic diseases.in: Marcus R Feldman D Kelsey J Osteoporosis. Academic Press, San Diego2001: 237-258
- Celiac sprue.N Engl J Med. 2002; 346: 180-188
- Bone histomorphometry in celiac disease.Ann Chir Gynaecol. 2001; 90: 100-104
- Osteoporosis in adult patients with celiac disease.Bone. 1999; 24: 249-255
- Osteoporosis in a North American adult population with celiac disease.Am J Gastroenterol. 2001; 96: 112-119
- Risk of fractures in celiac disease patients: a cross-sectional, case-control study.Am J Gastroenterol. 2000; 95: 183-189
- Bone loss in celiac disease is related to secondary hyperparathyroidism.J Bone Miner Res. 1999; 14: 652-657
- Differential diagnosis and secondary causes of osteoporosis.Clin Cornerstone. 2000; 2: 11-21
- Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency.Int J Pancreatol. 2000; 27: 21-27
- Hepatic osteodystrophy: a review.Hepatogastroenterology. 1997; 44: 574-581
- Bone mineral density, serum insulin-like growth factor I and bone turnover markers in viral cirrhosis.Hepatology. 1998; 28: 695-699
- Ethanol reduces bone formation and may cause osteoporosis.Am J Med. 1989; 86: 282-288
- Bone disorder in men with chronic alcoholism: A reversible disease?.J Clin Endocrinol Metab. 1991; 73: 118-124
- Transplantation osteoporosis.in: Seibel M.J Robins S.P Bilezikian J.P Dynamics of bone and cartilage metabolism. Academic Press, San Diego1999: 515-526
- Transplantation osteoporosis.in: Marcus R Feldman D Kelsey J Osteoporosis. Academic Press, San Diego2001: 327-340
- Increased risk of fracture in patients receiving solid organ transplants.J Bone Miner Res. 1999; 14: 456-463
- Osteogenesis imperfectata and other defects of bone development as occasional causes of adult osteoporosis.in: Marcus R Feldman D Kelsey J Osteoporosis. Academic Press, San Diego2001: 271-302
- Secondary osteoporosis.Balliere Clin Endocrinol Metab. 1997; 11: 83-99
- Diagnostic challenges in osteoporosis.Can Fam Physician. 2001; 47: 1244-1250
Lindsay R, Cosman F. Osteoporosis. p. 623–42.
- Diagnostic challenges in osteoporosis.Canadian Family Physician. 2001; 47: 1244-1250
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