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Secondary Osteoporosis

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The cause of secondary osteoporosis is completely different from primary osteoporosis. The former is consequence of side effect of drugs, hormonal and various types of health disorders, etc.  Such medical circumstances can lead to bone loss and bone fragility. In case of secondary osteoporosis, the problem doesn’t lie in the bone but is induced from a direct cause.

Symptoms of secondary osteoporosis

Secondary osteoporosis is in itself asymptomatic, unless the person gets fracture due to weak bones.  However, symptoms of the primary disease will definitely be present. Since the primary disease leads to osteoporosis, doctors will look for symptoms of pain in back and abnormality in the posture of the body.

Causes of secondary osteoporosis

Since the reasons behind secondary osteoporosis are diverse, we categorise them as:

Medical and Hormonal conditions

  • Rheumatoid arthritis
  • Chronic kidney disease
  • Liver disease
  • Anorexia
  • Pancreatic disease
  • Pulmonary diseases
  • Graves Disease – Hyperthyroidism
  • Sex hormone deficiency
  • Diabetes mellitus
  • Cushing’s syndrome
  • Vitamin D deficiency
  • Spinal cord injury
  • Leukemia and lymphomas
  • Celiac disease
  • Hypercortisolism
  • Multiple sclerosis
  • Premature menopause
  • Crohn’s disease

Drugs and chemicals that lead to secondary osteoporosis

  • Anticoagulants, these anti clotting medicines can interfere with absorption of vitamin K and D, resulting in bones with low mineral density
  • Anticonvulsants can hinder metabolism of the vitamin d, which aids in bone mineralization
  • Anti-neoplastics are used for treatment of cancer. They tend to lower synthesis of sex hormones. Ex: aromatase inhibitors, Tamoxifen
  • Antacids that contain aluminium interfere with absorption of calcium and proton pump inhibitors.
  • Some other drugs are antipsychotic, anti-depressants, barbiturates, aromatase inhibitors, antiretroviral, corticosteroids, etc.
  • Alcohol abuse and excessive smoking

Complications of secondary osteoporosis

Secondary osteoporosis can have the following complications:

  • Vertebrae fracture
  • Colles fracture
  • Hip fracture
  • Wrist fracture

The aforementioned are major types of fractures and the post fracture complications can be severe enough to be fatal especially for old people.

Diagnosis of secondary osteoporosis

Diagnosis of secondary osteoporosis involves a comprehensive study of the medical condition that has lead to bone loss.  You need to present the reports of your medical treatments and drugs. Furthermore, your doctor will also enquire about your smoking and drinking habits and probable family history of osteoporosis.

If he/she suspects secondary osteoporosis, then you need to undergo a Bone Mineral Density (BMD) test. The technique, known as DEXA scan or dual X ray absorptimetry, is performed at the spine, hip or the lumbar region to estimate the risk of fracture.

Blood and urine tests are performed to check metabolism of bones. This helps to diagnose the progression of the disease. The blood tests also determine density of bone minerals like calcium, phosphate and other minerals.

However, apart from bone tests one might also need to undergo several other tests like kidney tests, liver function tests, etc. to rule out the underlying cause of secondary osteoporosis.

Treatment of secondary osteoporosis

The treatment of secondary osteoporosis is much complicated than osteoporosis as the former entails curing the primary cause as well the osteoporosis.

Therefore, we can say that the first line of treatment involves healing the patient from the medical condition, hormonal complications, etc. Drug induced osteoporosis needs careful scrutiny of the dosage and then modifying it without causing any side effects. An alternative approach may also be suggested by your doctor.

Drugs used to improve bone mineral density are vitamin D and calcium supplements. Bisphosphonates may be suggested by doctors. They can be taken orally or are given intravenously. Lastly surgery may also be performed when there’s fracture.

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Written by: Saptakee sengupta
Date last updated: January 29, 2015