Secondary Osteoporosis

What is Secondary Osteoporosis?

Osteoporosis is a condition where the structure of the bones weakens, making them fragile and more prone to break even from minor falls or, in severe cases, from a sneeze or sudden movements. This problem mainly impacts women after menopause, a time when a rapid decrease in bone mass can happen due to the loss of estrogen’s protective effect on bones. However, this condition also significantly impacts women before menopause and young men who experience bone fractures due to other underlying reasons resulting in bone loss.

According to different studies, the secondary causes of osteoporosis can influence two-third of older men, more than half of women before menopause, and 30% of women after menopause.

These secondary reasons leading to bone loss could be any underlying illness or condition or even the use of certain medicines that either prevent the attainment of full bone mass during young adulthood or lead to excessive bone loss, which can harm the overall bone health and its quality.

What Causes Secondary Osteoporosis?

Secondary osteoporosis is a bone condition caused by other health problems or conditions, such as:

Endocrine Problems

a. Primary Hyperparathyroidism (PHPT): This often occurs in people over 50 years of age and can be due to various causes, including an overactive single gland, a condition of hyperactive glands, or rarely, cancer. Some people’s family history makes them more prone to this condition.

b. Cushing’s Syndrome: People with Cushing syndrome are at a higher risk for osteoporosis-related fractures, this is because they tend to have increased bone break down and decreased bone formation.

c. Hyperthyroidism: This is a condition where the thyroid gland is overactive. People with this condition can have weakened bones.

d. Hypogonadism and Premature Ovarian Insufficiency (POI), aka early menopause: This condition involves loss of ovarian function before 40 years of age. This can lead to osteoporosis, which is a significant health concern for these individuals. Other risk factors also play a role in determining bone quality for this group.

e. Diabetes Mellitus: Both types of diabetes (type 1 and type 2) are associated with an increased risk of fractures due to weakened bones. Certain medications for diabetes have also been linked to increased risk for osteoporosis.

Chronic Inflammatory Conditions

a. Rheumatoid arthritis: People with this condition have a higher chance of developing osteoporosis.

b. Cystic fibrosis: This disease can also lead to bone-related diseases and a higher chance of fractures.

c. Chronic Obstructive pulmonary disease (COPD): Approximately one-third of people with COPD suffer from osteoporosis.

Chronic Kidney Disease: Chronic kidney diseases are increasingly being associated with bone diseases.

Idiopathic Hypercalciuria: This refers to high levels of calcium in the urine, which is often associated with an increased risk of fractures.

Neuromuscular Diseases

a. Cerebral palsy: This condition can also lead to a higher risk of osteoporosis.

b. Spina Bifida: Patients with this condition tend to have a higher risk for osteoporosis.

c. Duchenne’s muscular dystrophy (DMD): This condition can significantly increase the risk of osteoporosis.

d. Multiple Sclerosis: People with this condition are twice as likely to have osteoporosis and osteoporotic fractures.

e. Parkinson’s disease: Patients with this condition have higher fracture-related death rates.

f. Post stroke: Stroke survivors are at a higher risk for osteoporosis due to bone loss from immobilization and neurologic disability.

Gastrointestinal Diseases

a. Inflammatory Bowel Disease: People with these conditions have a higher risk of osteoporosis and fractures.

b. Celiac disease: This condition causes nutrient absorption problems leading to higher chances of bone loss and osteoporosis.

c./d./e. Any form of chronic liver disease is associated with a higher risk of fractures and osteoporosis due to impaired liver functions.

Nutritional Conditions

a. Anorexia nervosa: People with this condition have decreased bone mass and a higher risk of osteoporosis.

b. Obesity: Some obese patients might still lose bone density at a higher rate.

c. A history of bariatric surgery: Patients with a history of weight-loss surgery face a higher risk of osteoporosis.

Glucocorticoid Induced Osteoporosis: This condition is characterized by increased bone loss due to steroid use. It’s important to treat patients with a higher risk for osteoporosis fractures who are on steroid treatment.

Post-transplant Osteoporosis: With improvements in medical treatments and more people benefiting from transplants, it’s important to evaluate the bone health of these patients as they are also at risk of developing osteoporosis.

HIV Infection: HIV and the related therapy increase the risk of bone loss and osteoporosis.

Medications/Adverse Lifestyle Factors: Several medications and lifestyle factors such as smoking and alcohol use can also lead to bone loss and hence, osteoporosis.

Cancer and Bone: Bone health is also a concern for patients with certain types of cancer or pre-cancerous conditions.

Genetic Diseases: Genetic conditions like Thalassemia and Ehlers-Danlos syndrome are also associated with increased risk of osteoporosis.

Risk Factors and Frequency for Secondary Osteoporosis

Osteoporosis is a health problem that affects many people around the world. Research shows that 30% of post-menopausal women and between 50% to 80% of men have additional factors causing secondary osteoporosis. In the United States, it’s estimated that osteoporosis affects around 20 to 25 million people and is responsible for about two million fractures every year.

If we look at the global scale, osteoporosis causes more than 8 million fractures per year, which means an osteoporosis-related fracture occurs roughly every 3 seconds. According to the World Health Organization’s definition, around 6% of men and 21% of women over the age of 50 suffer from osteoporosis. With these numbers, it’s estimated that osteoporosis affects roughly 500 million people worldwide.

• About 30% of post-menopausal women and 50% to 80% of men have additional factors that contribute to secondary osteoporosis.
• 20-25 million people in the United States might be affected by osteoporosis.
• Every year, osteoporosis is responsible for around two million fractures in the United States.
• Globally, there’s one fracture related to osteoporosis approximately every 3 seconds.
• According to the World Health Organization, osteoporosis affects around 6% of men and 21% of women over 50.
• It’s estimated that around 500 million people worldwide could be affected by osteoporosis.

Signs and Symptoms of Secondary Osteoporosis

Osteoporosis is often a quiet condition, meaning you may not notice any signs until a bone breaks easily, indicating that the disease might be present. This is why doctors often rely on tests and patients’ medical histories to help diagnose it.

This condition is associated with having lower bone density and a decreased bone mass index. During a physical exam, doctors may notice a hunched posture or a decrease in your height due to spinal fractures caused by osteoporosis. However, it’s important to note that osteoporosis often has no noticeable symptoms in its early stages. It’s usually identified through a specific type of X-ray called a DXA scan or after a bone breaks easily, a sign known as a fragility fracture.

Testing for Secondary Osteoporosis

If you are a premenopausal woman with osteoporosis or a man under 50 years old experiencing weak bones or bone fractures, your doctor may want to explore further, looking for other potential health issues causing your bone loss. This is known as searching for secondary causes of osteoporosis.

Your doctor will typically start with a bone density test, the go-to method for diagnosing osteoporosis and bone strength. This test is called a DXA scan. If needed, spine x-rays might be taken as well, especially if your doctor suspects there may be fractures.

Another tool doctors might use is something called HRp QCT, which examines the small-scale structure of your bones. There are cases when the doctor may suggest taking a small sample of your bone tissue, known as a bone biopsy, especially when they are having difficulty determining the cause of severe osteoporosis.

The doctor can diagnose osteoporosis through a DXA scan if your t-score, a measure that compares your bone density with that of a healthy 30-year-old adult, is -2.5 or less. Diagnosis can also happen if you’ve experienced fractures after minor injury, which shouldn’t typically lead to fractures.

Another approach to evaluating osteoporosis risk is through the FRAX score, which calculates your risk of having a major bone fracture within the next ten years. However, this method might not be as effective for people under 40 years old or those who have worse spinal bone density.

In some cases, patients have fracturing bones despite having normal bone mass. This situation can occur with conditions like diabetes. To understand this better, a bone quality measure related to structure called the trabecular bone score (TBS) is used.

In addition to these, your doctor may run a range of other tests to uncover possible secondary causes of osteoporosis. This extended list might include blood count tests, inflammatory condition checks, bone, kidney and liver function checks, diabetes evaluation, hormonal level examination, thyroid checks, and many others. The complete list of tests would depend on your specific symptoms and individual case.

Keep in mind that these measures are to figure out what might be contributing to your bone loss, and accordingly, to plan the best course of action for your treatment.

Treatment Options for Secondary Osteoporosis

For patients suffering from secondary osteoporosis, it’s crucial to identify and treat any underlying health issues that may be contributing to the problem. Until these conditions are addressed, it may be difficult for the patient to reap the full benefits of standard osteoporosis treatments.

Ensuring a sufficient intake of calcium and vitamin D can help strengthen the bones. In addition, other lifestyle changes, such as regular weight-bearing exercises and avoidance of smoking and alcohol, can also be beneficial. Studies have shown that these practices can help to increase bone strength and reduce the risk of fractures.

Once any underlying health issues have been addressed, patients may be prescribed medications such as antiresorptive agents like bisphosphonates or denosumab. These drugs help slow the breakdown of bone, preserving bone mass and reducing the risk of fractures. Denosumab, which is administered via an injection under the skin, is also effective for patients with kidney problems, as it doesn’t need kidneys to be eliminated from the body.

Another category of medications that might be used includes anabolic agents, such as Teriparatide and Abaloparatide. These medications stimulate the formation of new bone, and are typically used in severe osteoporosis cases, or in patients who cannot tolerate or have not responded well to other treatments.

Different underlying conditions require specific management approaches. For example, osteoporosis associated with endocrine disorders can often be successfully managed by treating the underlying disease – whether it’s hyperparathyroidism, Cushing’s syndrome, hyperthyroidism, hypogonadism, or diabetes.

People with chronic inflammatory conditions and diseases, such as rheumatoid arthritis and cystic fibrosis, or chronic kidney disease may also require particular treatments. Their doctors may prescribe bone-strengthening drugs and make recommendations relating to diet and exercise, among other things.

Those suffering from secondary osteoporosis due to hypercalciuria, neuromuscular disease, gastrointestinal diseases, malnutrition, glucocorticoid-induced osteoporosis, post-transplant osteoporosis, HIV/infections, cancer and genetic conditions also require individually tailored approaches to managing their osteoporosis.

In the end, each patient is unique and the treatment of secondary osteoporosis should address their specific health conditions and needs, with the overall aim of improving bone health and reducing the risk of fractures.

What else can Secondary Osteoporosis be?

When looking into the causes of secondary osteoporosis, medical professionals would consider the possibility of several different conditions. These could include:

• Osteomalacia (softening of the bones)
• Renal osteodystrophy (a bone disorder related to kidney disease)
• Lymphoma (a type of cancer)
• Mastocytosis (overproduction of mast cells)
• Sickle cell anemia (a blood disorder)
• Multiple myeloma (a cancer of plasma cells)
• Paget’s disease (a bone disorder that typically occurs in older adults)
• Osteonecrosis (loss of blood flow to the bones)
• Infections that could affect the bones
• Homocystinuria (an inherited disorder affecting the metabolism of the amino acid methionine)
• Scurvy (a disease caused by a lack of vitamin C)
• Homocysteinemia (high levels of homocysteine in the blood)
• Metastatic bone disease (cancer that has spread to the bones)

It’s necessary for physicians to check these potential causes when diagnosing secondary osteoporosis.

What to expect with Secondary Osteoporosis

People with a condition called secondary osteoporosis may face a small increase in overall health complications due to fractures in the spine and hip, and the issues that come along with these fractures like blood clots in the lungs (pulmonary embolism), blood clots in deep veins usually in the leg (deep vein thrombosis) and pneumonia, a type of lung infection.

These individuals may also suffer from compression fractures; breaks in the bones of the spine that can reduce overall quality of life, cause lasting nerve-related pain, negatively affect breathing, and lead to abnormal changes in the shape of the spine.

Possible Complications When Diagnosed with Secondary Osteoporosis

It’s important to address other causes of osteoporosis early on to avoid potential issues such as fractures and a decreased quality of life.

If osteoporosis results in fractures, it could lead to problems like trouble moving around or continual pain. This can even cause mental health problems, such as depression.

Even young people can experience a reduced quality of life and increased physical dependence due to osteoporosis.

Potential Problems of Osteoporosis:

• Fractures
• Reduced quality of life
• Limited mobility
• Chronic pain
• Depression
• Increased physical dependence at a young age

Preventing Secondary Osteoporosis

If you have been diagnosed with a disease that can lead to osteoporosis (a medical condition where bones become weak and brittle), it’s important to understand the factors that could contribute to this bone loss. Knowing these risk factors is the first step in preventing osteoporosis, identifying the condition early, and getting effective treatment. Your doctor, especially if they are a primary care physician, should help you understand your specific disease and possible complications, including the risk of developing osteoporosis.

Once osteoporosis has been diagnosed, your doctor will take time to explain how you can help prevent any further bone loss. They will offer advice about potential treatment options and medications. It’s important that you play an active role in managing the disease by reducing risk factors and following the suggested treatment plan.