What causes secondary osteoporosis?

Updated: Sep 26, 2019
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis (see Table 3, below). Up to one third of postmenopausal women, as well as many men and premenopausal women, have a coexisting cause of bone loss, [43, 44] of which renal hypercalciuria is one of the most important secondary causes of osteoporosis and treatable with thiazide diuretics. [45]

Table 3. Causes of Secondary Osteoporosis in Adults (Open Table in a new window)

Cause

Examples

Genetic/congenital

  • Renal hypercalciuria – one of the most important secondary causes of osteoporosis; can be treated with thiazide diuretics

  • Cystic fibrosis

  • Ehlers-Danlos syndrome

  • Glycogen storage disease

  • Gaucher disease

  • Marfan syndrome

  • Menkes steely hair syndrome

  • Riley-Day syndrome

  • Osteogenesis imperfecta

  • Hemochromatosis

  • Homocystinuria

  • Hypophosphatasia

  • Idiopathic hypercalciuria

  • Porphyria

  • Hypogonadal states

Hypogonadal states

  • Androgen insensitivity

  • Anorexia nervosa/bulimia nervosa

  • Female athlete triad

  • Hyperprolactinemia

  • Panhypopituitarism

  • Premature menopause

  • Turner syndrome

  • Klinefelter syndrome

Endocrine disorders [46]

  • Cushing syndrome

  • Diabetes mellitus

  • Acromegaly

  • Adrenal insufficiency

  • Estrogen deficiency

  • Hyperparathyroidism

  • Hyperthyroidism

  • Hypogonadism

  • Pregnancy

  • Prolactinoma

Deficiency states

  • Calcium deficiency

  • Magnesium deficiency

  • Protein deficiency

  • Vitamin D deficiency [46, 47]

  • Bariatric surgery

  • Celiac disease

  • Gastrectomy

  • Malabsorption

  • Malnutrition

  • Parenteral nutrition

  • Primary biliary cirrhosis

Inflammatory diseases

  • Inflammatory bowel disease

  • Ankylosing spondylitis

  • Rheumatoid arthritis

  • Systemic lupus erythematosus

Hematologic and neoplastic disorders

  • Hemochromatosis

  • Hemophilia

  • Leukemia

  • Lymphoma

  • Multiple myeloma

  • Sickle cell anemia

  • Systemic mastocytosis

  • Thalassemia

  • Metastatic disease

Medications

  • Anticonvulsants

  • Antipsychotic drugs

  • Antiretroviral drugs

  • Aromatase inhibitors

  • Chemotherapeutic/transplant drugs: cyclosporine, tacrolimus, platinum compounds, cyclophosphamide, ifosfamide, high-dose methotrexate [48]

  • Furosemide

  • Glucocorticoids and corticotropin [49] : prednisone (≥5 mg/day for ≥3 mo) [50]

  • Heparin (long term)

  • Hormonal/endocrine therapies: gonadotropin-releasing hormone (GnRH) agonists, luteinizing hormone-releasing hormone (LHRH) analogues, depomedroxyprogesterone, excessive thyroxine

  • Lithium

  • Selective serotonin reuptake inhibitors (SSRIs)

Miscellaneous

  • Alcoholism

  • Amyloidosis

  • Chronic metabolic acidosis

  • Chronic heart failure

  • Depression

  • Emphysema

  • Chronic or end-stage renal disease

  • Chronic liver disease

  • HIV/AIDS

  • Idiopathic scoliosis

  • Immobility

  • Multiple sclerosis

  • Ochronosis

  • Organ transplantation

  • Pregnancy/lactation

  • Sarcoidosis

  • Weightlessness [51]

Sources:

(1) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. Nov-Dec 2003;9(6):544-64. [43]

(2) Kelman A, Lane NE. The management of secondary osteoporosis. Best Pract Res Clin Rheumatol. Dec 2005;19(6):1021-37. [44]


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