What causes secondary osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; 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). [53] Up to one third of postmenopausal women, as well as many men and premenopausal women, have a coexisting cause of bone loss, [11, 54] of which renal hypercalciuria is one of the most important secondary causes of osteoporosis and treatable with thiazide diuretics. [55]

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

  • Idiopathic hypercalciuria

  • Hypogonadal states

Hypogonadal states

  • Androgen insensitivity

  • Anorexia nervosa/bulimia nervosa

  • Female athlete triad

  • Hyperprolactinemia

  • Panhypopituitarism

  • Premature menopause

  • Turner syndrome

  • Klinefelter syndrome

Endocrine disorders [56]

  • Cushing syndrome

  • Diabetes mellitus

  • Acromegaly

  • Adrenal insufficiency

  • Estrogen deficiency

  • Growth hormone deficiency

  • Hypercortisolism

  • Hyperparathyroidism

  • Hyperthyroidism

  • Hypogonadism

  • Hypophosphatasia

  • Pregnancy

  • Porphyria

  • Prolactinoma

Deficiency states and malabsorption syndromes

  • Alcoholism

  • Anorexia nervosa

  • Calcium deficiency

  • Magnesium deficiency

  • Protein deficiency

  • Vitamin D deficiency [56, 57]

  • Bariatric surgery

  • Celiac disease

  • Cystic fibrosis

  • Gastrectomy

  • Malnutrition

  • Parenteral nutrition

  • Chronic liver disease

Inflammatory diseases

  • Inflammatory bowel disease/Crohn 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 [58]

  • Furosemide

  • Glucocorticoids and corticotropin [59] : prednisone (≥5 mg/day for ≥3 mo) [60]

  • Heparin (long term)

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

  • Lithium

  • Proton pump inhibitors

  • Selective serotonin reuptake inhibitors (SSRIs)

  • SGLT2- inhibitors

  • Thiazolidinediones

Miscellaneous

  • Amyloidosis

  • Chronic metabolic acidosis

  • Chronic heart failure

  • Chronic obstructive pulmonary disease (COPD)

  • Chronic or end-stage renal disease

  • HIV/AIDS

  • Idiopathic scoliosis

  • Immobility

  • Major Depression

  • Multiple sclerosis

  • Ochronosis

  • Organ transplantation

  • Renal insufficiency/ failure

  • Renal tubular acidosis

  • Sarcoidosis

  • Weightlessness [61]

Sources:

(1) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2020 update. Endocr Pract. May2020; 26(Suppl 1):1-46. [11]

(2) Kelman A, Lane NE. The management of secondary osteoporosis. Best Pract Res Clin Rheumatol. Dec 2005;19(6):1021-37. [54]


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