OsteoEd

Common Questions

Who should be evaluated for secondary causes of osteoporosis?

No evidence-based guidelines define who should be evaluated for secondary osteoporosis. The definition of primary versus secondary osteoporosis itself is quite arbitrary as a patient with hypogonadism early in life may have secondary osteoporosis, but a postmenopausal woman without other secondary causes would be defined as having primary osteoporosis. Any patients may have a combination of primary and secondary osteoporosis. These definitions may instead help determine who may have reversible or treatable causes of osteoporosis.

The following groups have a high incidence of secondary causes of osteoporosis and should be screened when encountered:

  • Premenopausal women with fragility fractures
  • Anyone with a z-score of -2.0 or less
  • Men with low/moderate impact fracture
Secondary causes of osteoporosis
Disorder Cause
Endocrine disorders
  • Hyperparathyroidism
  • Cushing's syndrome/Hypercortisolism
  • Hypogonadism
    • Female:
      • Anorexia nervosa
      • Hypothalamic amenorrhea
      • Premature and primary ovarian failure
    • Male:
      • Congenital (e.g. Klinefelter syndrome)
      • Acquired (e.g. orchitis, hemochromatosis)
  • Hyperprolactinemia/Prolactinoma
  • Diabetes mellitus
  • Acromegaly/Growth hormone deficiency
  • Pregnancy and lactation
Hematopoietic disorders
  • Plasma cell dyscrasias (e.g. multiple myeloma, macroglobulinemia)
  • Systemic mastocytosis
  • Leukemias and lymphomas
  • Disseminated carcinoma
  • Sickle cell disease and thalassemia minor
  • Myelproliferative disorders (e.g. polycythemia)
Connective Tissue disorders
  • Osteogenesis imperfecta
  • Ehlers-Danlos syndrome
  • Marfan's syndrome
  • Homocystinuria and lysinuria
  • Menkes' syndrome
  • Scurvy
Gastrointestinal and Nutritional disorders
  • Malabsorption syndromes
  • Subtotal gastrectomy/Total gastrectomy
  • Total parenteral nutrition
  • Hepatobiliary disease
  • Chronic liver disease
  • Chronic hypophosphatemia
  • Inflammatory bowel disease
  • Celiac sprue
  • Immobilization
Renal disorders
  • Chronic renal failure
  • Renal tubular acidosis
Drugs
  • Corticosteroids
  • Anticonvulsants
  • Lithium
  • Heparin
  • Thyroxine
  • Cyclosporine
  • Methotrexate
  • Aluminum
  • Medroxyprogesterone acetate
  • Aromatase inhibitors
  • Gonadotropin-releasing hormone agonists
  • Alcohol
Miscellaneous
  • Rheumatoid arthritis
  • Reflex sympathetic dystrophy
  • Familial dysautonomia
  • Post-organ transplantation
  1. Tannirandorn P, Epstein S. Drug-Induced Bone Loss. Osteoporosis International 2000; 11: 637-659.
  2. Larsen. Williams Textbook of Endocrinology. 2003; 10th ed: 1389-1390.
  3. Favus M. Primer on metabolic bone diseases and disorders of mineral metabolism. Lippencott, Williams & Wilkins 1999; 4th ed.
  4. Hodgson SF, Watts NB, Bilezikian JP, Clarke BL, Gray TK, Harris DW, Johnston CC, et al. 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 2003; 9(6): 544-564.
Last updated 2006-05-18