New tools for detecting occult monoclonal gammopathy, a. In cases of primary osteoporosis, either the condition is caused by agerelated bone loss sometimes called senile osteoporosis or the cause is unknown idiopathic osteoporosis. Jun 01, 2016 secondary osteoporosis results from specific clinical disorders that are potentially reversible. This article will further address the endocrine system. Secondary osteoporosis results from specific clinical disorders that are potentially. Osteoporosis can be secondary to an underlying metabolic, nutritional, pharmacologic or diseaserelated cause. Secondary causes of osteoporosis in fracture patients. Approach to the patient with secondary osteoporosis in. 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. See a doctor immediately if you are experiencing severe pain, particularly of the back, neck, hip.
The estimated risk of major osteoporotic and hip fractures was significantly higher in women with secondary osteoporosis compared to men and also compared to women with primary osteoporosis. There are numerous causes of secondary bone loss, including adverse effects of drug therapy, endocrine disorders, eating disorders, immobilization, marrowrelated. Vitamin d is a fat soluble vitamin which regulates the formation of bone and the absorption of calcium from the intestine. Study conducted on an in and outpatient basis in a referral italian endocrinology unit. No no na offer pharmacologic treatment for primary osteoporosis. Glucocorticoids glukokortikoids, often referred to as steroids, are the most common cause of secondary osteoporosis. Patients diagnosed with low bone mass by dexa tscore between 1. Of these 55 patients, 43 had a secondary cause identified for the low bone mineral density 24 patients were diagnosed with a previously unrecognised factor and 19 were already known to have a secondary cause before evaluation and 12 patients had steroid induced osteoporosis defined as. Jul 11, 2014 secondary osteoporosis, on the other hand, is the type of osteoporosis that has a direct cause. Primary osteoporosis is known as either being agerelated osteoporosis, or an unknown cause. 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. In addition, low bmd zscores agematched comparison identify individuals requiring further evaluation for secondary causes of osteoporosis. Osteoporosis symptoms can cause pain and discomfort.
Secondary osteoporosis international osteoporosis foundation. Many times reversible, secondary causes of bone loss are not considered in a patient with low bone mineral density bmd. 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 mayo clinic proceedings. Secondary causes of osteoporosis should be considered in patients who suffer a fragility fracture when traditional risk factors are insufficient to explain the injury. Secondary osteoporosis is caused by certain medical conditions or treatments that interfere with the attainment of peak bone mass and may cause bone loss. Recorded data of the patients are evaluated retrospectively. In secondary osteoporosis, additional treatment may be necessary to treat the original cause of osteoporosis. Readers will consider when changes in bone mineral density merit an evaluation for a monoclonal gammopathy new tools for detecting occult monoclonal gammopathy, a cause of secondary osteoporosis abstract most patients with multiple myeloma or other monoclo. Testing for secondary causes of osteoporosis the bmj. May 04, 2018 while it is difficult to undo the damage that is caused by secondary osteoporosis, with proper use of medications, individuals can mend their bones and overcome any injuries that they suffer. Secondary causes of osteoporosis including diabetes insulin dependent, osteogenesis imperfecta in adults, untreated longstanding hyperthyroidism, premature menopause or hypogonadism in men, chronic malnutrition or malabsorption, chronic liver disease, drugs such as aromatase inhibitors.
On the other hand, many patients with achy hips or feet assume that their complaints are due to osteoporosis. Bone is living tissue that is constantly being broken down and replaced. Bone loss is a common side effect of these medications. Tests to determine secondary causes of bone loss american.
No yes na treat the secondary cause and recheck dexa in 23 years, or consider an econsult with endocrinology. Secondary osteoporosis, children, low bone mineral density. Feb 27, 2019 secondary osteoporosis, which can affect both adults and children, results from another primary disorder or therapy such as juvenile rheumatoid arthritis where the disease process itself can cause. Secondary osteoporosis should especially be considered and extensively investigated in. New tools for detecting occult monoclonal gammopathy, a cause of secondary osteoporosis. Secondary osteoporosis can be present in pre and postmenopausal women and in men. Osteoporosis, a major public health problem, is becoming increasingly. Investigation of causes of secondary osteoporosis can inform and influence specific treatment regimens. Medications that can cause secondary osteoporosis many chronic illnesses require longterm use.
Understanding the difference between primary and secondary. Conditions that require frequent exposure to steroids, such as rheumatoid arthritis, organ transplants, chronic pulmonary disease and inflammatory bowel disease, have strong associations with osteoporosis as well. Yes yes na offer pharmacologic treatment for primary osteoporosis, and treat the secondary cause or consider an econsult with endocrinology. Secondary causes of osteoporosis and low bone density. Other secondary causes of osteoporosis primer on the.
The term secondary applies to patients in whom the identifiable causal factors are other than aging and menopause. However, there are a number of medical conditions and medications that can cause more rapid. Like primary osteoporosis, secondary osteoporosis is characterized by weak bones that have lost bone density. Secondary osteoporosis drugs and diseases that can cause. Secondary causes of osteoporosis can be divided into several categories. Secondary osteoporosis is defined as low bone mass with microarchitectural alterations in bone leading to fragility fractures in the presence of an underlying disease or medication. A recent pooled analysis of several studies suggests that 58% of men have an underlying secondary cause of osteoporosis 17. Even the long term use of oral corticosteroids can cause hypercortisolism, which increases the chance of developing this particular type of osteoporosis. It is important to identify those children at risk for osteoporosis due to causes related. More than onehalf of patients sustaining a fragility fracture and referred to the mbdc were vitamin d insufficient or deficient, and nearly onethird had a secondary cause of osteoporosis other than vitamin d insufficiency. Secondary osteoporosis, on the other hand, is the type of osteoporosis that has a direct cause. Postmenopausal women and persons at risk for secondary osteoporosis related to longterm glucocorticoid use, organ transplant, or other medical conditions. Up to 30% of postmenopausal women and 50% of men with osteoporosis may have an underlying cause.
Jan 11, 2010 when treating osteoporosis we cant expect to see improvements overnight, but on the other hand you should see some improvements at some point in the near future, unless you have a secondary cause. There are numerous causes of secondary bone loss, including adverse effects of drug therapy, endocrine disorders. The chart above includes a list of common conditions known to cause secondary osteoporosis. Primary aldosteronism as a cause of secondary osteoporosis article in european journal of endocrinology 1775.
Secondary causes of bone loss are not often considered in patients who are diagnosed as having osteoporosis. Secondary osteoporoses are the consequence of specific clinical disorders and medications, including a variety of endocrine, gastrointestinal, rheumatologic, and genetic diseases that cause low bone mineral density bmd, either by interfering with attainment of peak bone mass or by increasing rates of involutional bone loss. Drugs and diseases that can cause bone loss, falls andor fractures. Sometimes, osteoporosis can be the presenting sign of a monoclonal gammopathy, which in some people may precede a diagnosis of multiple myeloma. Apr 30, 20 people suffering from osteoporosis are susceptible to hip, spine and long bone fractures. In this study we summarize the causes of secondary osteoporosis we encountered in patients currently on followup in our osteoporosis outpatient clinic. Secondary osteoporosis is caused by other health conditions table 4. Secondary causes of osteoporosis and low bone density michael maricic, m. Is there really such a thing as primary osteoporosis. Giop is the most common iatrogenic cause of osteoporosis. Medications that can cause bone loss, falls andor fractures. Pdf a practical approach to secondary osteoporosis case.
For example, osteoporosis caused by the use of prednisone is a very common form of secondary osteoporosis. Secondary causes of osteoporosis creighton school of medicine. Drugs known to cause osteoporosis andor fragility fractures. 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. She was otherwise healthy, had no notable medical history, and took no medications. Secondary osteoporosis is characterized by low bone mass with microarchitectural alterations in bone leading to fragility fractures in the presence of an underlying disease or medication. Recognizing and treating secondary osteoporosis nature. 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. How to minimize the harmful effects this fact sheet may not include all medications or all medical conditions that can contribute to fractures. Osteoporosis screening, diagnosis, and treatment guideline. This type of osteoporosis is secondary to, or caused by, something else. Secondary osteoporosis is caused by certain diseases and treatments that interfere with bone density and cause bone loss. Expert panel consensus recommendations for diagnosis and. The most commonly reported secondary causes of osteoporosis in men include hypogonadism and.
New tools for detecting occult monoclonal gammopathy, a cause. Estrogen and progesterone are two hormones that play important roles in regulating the rate at which bone is lost. Glucocorticoids are steroid medications used to treat diseases such as asthma and rheumatoid arthritis. Osteoporosis in men nih osteoporosis and related bone. Osteoporosis is clinically classified into two categories, primary and secondary. Osteoporosis has no clinical manifestations until there is a fracture. Catalina pointe rheumatology clinical associate professor university of arizona, tucson. This affects the structure and strength of bones and makes fractures more likely. Life expectancy greatly varies in individuals with secondary osteoporosis because the cause is different amongst them. A total of 1015 female patients are involved in the study. This is an important fact because many patients without symptoms incorrectly assume that they must not have osteoporosis. Secondary osteoporosis comprises a minority of all osteoporosis cases. Primary aldosteronism as a cause of secondary osteoporosis.
Glucocorticoids can cause significant bone loss, particularly during the first 612 months of use b. While there is no cure for secondary osteoporosis, various treatments can help with reducing bone loss, strengthening bones, and. Secondary osteoporosis drugs and diseases that can cause bone loss, falls andor fractures part 4 december 20, 20 coping is brought to you by the canadian osteoporosis patient network copn every second friday. Measuring the concentration and ratio of free light chains in the serum can help detect monoclonal. 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. 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. Many physicians classify osteoporosis as primary type i or secondary type ii. The underlying pathogenesis of secondary osteoporosis is often multifactorial. 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. Apr, 2020 secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis see table 3, below. 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.
Secondary osteoporosis medications that can cause bone loss, falls andor fractures. Osteoporosisrelated fractures most commonly occur in the hip, wrist or spine. The term idiopathic osteoporosis is typically used only for men. Secondary osteoporosis results from chronic conditions that contribute significantly to accelerated bone loss.
Secondary causes of osteoporosis represent the collection of heterogeneous underlying diseases and medications that may. Mar 14, 2016 from there, the two main types of osteoporosis common in adults are. Themost common of these risk factors are age and female sex. Men are more likely to have a secondary cause of osteoporosis than women. Primary osteoporosis is associated with the normal loss of estrogen following the menopause as well as age. It is important to exclude secondary causes of osteoporosis as the treatment of. Secondary osteoporosis results from specific clinical disorders that are potentially reversible. Scenarios that are highly suspicious for secondary osteoporosis include fragility fractures in younger men or premenopausal women, very low bone. The average older woman with normal bone density loses about % of her bone density in 10 years or about 1. Secondary osteoporosis an overview sciencedirect topics. Some drugs that can lead to osteoporosis include corticosteroids and drugs to prevent seizures. 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.
But it is good to be suspicious when a z score is as low as in our second case. In some studies, 20% to 30% of postmenopausal women and more than 50% of men with osteoporosis have a secondary cause. The zscore is a comparison to agematched, sexmatched individuals. Research from the journal of osteoporosis shows that secondary osteoporosis affects at least 21 percent of men and 17. If secondary hyperparathyroidism has occurred due to vitamin d deficiency then it is important to treat with vitamin d supplementation. The cause of primary osteoporosis is obscure, though menopause in elderly women and aging in men are believed to be the underlying triggers. Up to one third of postmenopausal women, as well as many men and. Epidemiology, etiology, and diagnosis of osteoporosis american. Although secondary osteoporosis is less common, it is becoming more frequently diagnosed. Frequency and causes of osteoporosis in men rheumatology.
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