Secondary osteoporosis is characterized by low bone mass and microarchitectural deterioration in bone leading to fragility fractures when an underlying disease or medication is present. Clinical situations highly suspicious for secondary osteoporosis include fragility fractures in younger men or premenopausal women, very low bone mineral density (Z score < -2), and fractures occurring despite anti-osteoporotic therapy for ≥ 12 months. A detailed medical history and physical examination combined with laboratory tests aimed at identifying clinical risk factors for fractures, and underlying endocrine, gastrointestinal, hematologic, or rheumatic diseases, which then need to be confirmed by specific tests. Bone mineral density (BMD) should be assessed by bone densitometry using dual-energy x-ray absorptiometry (DXA) at both the hip and spine. Lateral thoracolumbar spinal x-rays or vertebral fracture assessment (VFA) by DXA should be performed to identify vertebral fractures, which are clinically silent in 70% of cases. Management of secondary osteoporosis includes treatment of the underlying disease, modification of medications known to adversely affect the skeleton, and specific anti-osteoporotic therapy. Calcium and vitamin D supplementation should be initiated with doses that result in normocalcemia and serum 25-hydroxyvitamin D concentrations of ≥30 ng/ml (75 nmol/L). Oral and intravenous bisphosphonates or denosumab are effective and safe drugs for most forms of secondary osteoporosis. However, severe osteoporosis may require the use of the anabolic drug, teriparatide, particularly if fractures have occurred on first-line therapy.
|Title of host publication||Osteoporosis|
|Subtitle of host publication||Diagnosis and Management|
|Editors||Dale W Stovall|
|Place of Publication||West Sussex UK|
|Number of pages||17|
|Publication status||Published - 2 Aug 2013|