Secondary Causes of Osteoporosis: Bone Diseases

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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.

Original languageEnglish
Title of host publicationOsteoporosis
Subtitle of host publicationDiagnosis and Management
EditorsDale W Stovall
Place of PublicationWest Sussex UK
Number of pages17
ISBN (Electronic)9781118316290
ISBN (Print)9781119968917
Publication statusPublished - 2 Aug 2013
Externally publishedYes


  • Bisphosphonates
  • Denosumab
  • Fractures
  • Glucocorticoids
  • Immunosuppressants
  • Men
  • Osteoporosis
  • Teriparatide

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