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  • Review Article
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Recognizing and treating secondary osteoporosis

Nature Reviews Rheumatology volume 8, pages 480–492 (2012)Cite this article

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Abstract

Osteoporosis, through its association with fragility fracture, is a major public health problem, costing an estimated $34.8 billion worldwide per annum. With projected demographic changes, the burden looks set to grow. Therefore, the prevention of osteoporosis, as well as its identification and treatment once established, are becoming increasingly important. Osteoporosis is secondary when a drug, disease or deficiency is the underlying cause. Glucocorticoids, hypogonadism, alcohol abuse and malnutrition are among the most frequently recognized causes of secondary osteoporosis but the list of implicated diseases and drugs is growing and some of the more recently recognized associations, such as those with haematological conditions and acid-suppressing medications, are less well publicized. In some cases, advancement in treatment of the primary disease has led to people living long enough to develop secondary osteoporosis; for example, successful treatment for breast and prostate malignancies by hormonal manipulation, improved survival in HIV with the advent of anti-retroviral therapies, and improved treatment for cystic fibrosis. This Review emphasizes the importance of secondary osteoporosis, discusses familiar and less well-known causes and what is known of their mechanisms, provides guidance as to the pragmatic identification of secondary osteoporosis and summarizes treatment options, where available.

Key Points

  • Osteoporosis and associated fragility fractures are major public health problems, but once fractures develop, it is already too late; thus, prevention is a priority

  • A growing number of diseases, deficiencies and drugs are recognised as causing secondary osteoporosis, and should be suspected as causes in particular among men and pre-menopausal women presenting with osteoporosis

  • In most cases, the general principle of treatment of secondary osteoporosis is to treat the underlying disease or deficiency, or to remove the relevant drug

  • Mechanisms of secondary osteoporosis vary and include low bone mass, increasing falls, and reduced bone quality—treatment strategies might need to be adapted for different patients

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Figure 1: A pragmatic algorithm for identifying treatable causes of secondary osteoporosis.
Figure 2: Measures that can be applied to the management of any patient who is at risk of, or has already developed, secondary osteoporosis.
Figure 3: Strategies for the prevention and treatment of secondary osteoporosis.
Figure 4: Causes of low bone mass in patients with HIV.

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Authors and Affiliations

  1. Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK

    Karen Walker-Bone

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Supplementary information

Supplementary Table 1

Studies of the estimated prevalence of secondary osteoporosis among women (DOC 69 kb)

Supplementary Table 2

Studies of the estimated prevalence of secondary osteoporosis among men (DOC 70 kb)

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Walker-Bone, K. Recognizing and treating secondary osteoporosis. Nat Rev Rheumatol 8, 480–492 (2012). https://doi.org/10.1038/nrrheum.2012.93

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