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# Secondary Osteoporosis
- URL: https://www.thephysiohub.uk/secondary-osteoporosis/
- Published: 2024-04-26T13:00:08.000Z
- Updated: 2024-04-26T13:00:08.000Z
- Description: Secondary Osteoporosis is the demineralisation and subsequent weakening of the bones causes by medical conditions, procedures and medications
- Author: Andy Hubbert
- Tags: Conditions, FCP, For Clinicians

Secondary Osteoporosis is the demineralisation and subsequent weakening of the bones causes by medical conditions, procedures and medications. These are characterised by causing bone loss, increasing fracture risk, directly affecting bone remodelling, indirectly affecting bone remodelling or interfering with the attainment of peak bone mass in younger individuals.

## Diseases/Conditions

- Autoimmune disorders  
  - Rheumatoid Arthritis
  - Lupus (SLE)
  - Ankylosing spondylitis
- Haematologic disorders  
  - Leukaemia
  - Lymphoma
  - Multiple Myeloma
  - Sickle cell disease
- Endocrine disorders  
  - Diabetes (T1 + T2)
  - Hyperthyroidism
  - Hyperparathyroidism
  - Cushing's Disease
  - Premature Menopause
  - Low testosterone levels in males
- Gastrointestinal Disorders  
  - Coeliac disease
  - Inflammatory bowel disease
  - Chronic liver disease
  - Chronic pancreatitis
- Cancers  
  - All due to chemotherapy
  - Breast cancer and prostate cancer higher risk
- Neurological Disorders  
  - Stroke
  - Parkinson's Disease
  - MS
  - Spinal Cord injuries
- Mental Illnesses  
  - Depression
  - Eating Disorders
- Others  
  - Cystic Fibrosis
  - HIV/AIDS
  - COPD
  - Immobility in general
  - Postpolio syndrome
  - Malnutrition and poor diet

## Medications

The table below is adapted from the International Osteoporosis Foundation and summarises things nicely:

| Drug Class                                     | Loss of Bone Mineral Density (BMD)                 | Examples                                           |
| ---------------------------------------------- | -------------------------------------------------- | -------------------------------------------------- |
| Androgen deprivation therapy (ADT)             | BMD declines by 2-5% during the first year of ADT. | oserelin, triptorelin, buserelin and leuprolide    |
| Aromatase inhibitors (AI)                      | Approx increase in loss of BMD of 0.5-1% per year  | anastrozole, exemestane and letrozole              |
| Glucocorticoids (GC)                           | All patients at increased risk of bone loss        | betamethasone, prednisolone, cortisone             |
| Selective serotonin reuptake inhibitors (SSRI) | Still under review but increased fracture risk     | citalopram, sertraline, fluoxetine                 |
| Thiazolidinediones (TZD)                       | Reduce bone formation and increase reabsorption    | Pioglitazone (can also be combined with metformin) |

Chemotherapy drugs, lithium and methotrexate are also linked with increased risk of osteoporosis and should also be considered.

![](https://cdn.synaps.media/physiohub/content/images/2024/04/jcm-11-02382-g001.png)

Taken from: Sobh, Mahmoud M., Mohamed Abdalbary, Sherouk Elnagar, Eman Nagy, Nehal Elshabrawy, Mostafa Abdelsalam, Kamyar Asadipooya, and Amr El-Husseini. ‘Secondary Osteoporosis and Metabolic Bone Diseases’. **Journal of Clinical Medicine* 11, no. 9 (January 2022): 2382\. [https://doi.org/10.3390/jcm11092382](https://doi.org/10.3390/jcm11092382?ref=thephysiohub.uk).

## References and Further Reading

About | International Osteoporosis Foundation \[WWW Document\], n.d. URL [https://www.osteoporosis.foundation/health-professionals/about-osteoporosis](https://www.osteoporosis.foundation/health-professionals/about-osteoporosis?ref=thephysiohub.uk) (accessed 3.2.24).  
Aromatase inhibitors (anastrozole, exemestane and letrozole) \[WWW Document\], n.d. . Breast Cancer Now. URL [https://breastcancernow.org/about-breast-cancer/treatment/hormone-endocrine-therapy/aromatase-inhibitors-anastrozole-exemestane-and-letrozole/](https://breastcancernow.org/about-breast-cancer/treatment/hormone-endocrine-therapy/aromatase-inhibitors-anastrozole-exemestane-and-letrozole/?ref=thephysiohub.uk) (accessed 3.2.24).  
Glucocorticoids: List, Uses, Side Effects, and More \[WWW Document\], 2020\. . Healthline. URL [https://www.healthline.com/health/glucocorticoids](https://www.healthline.com/health/glucocorticoids?ref=thephysiohub.uk) (accessed 3.2.24).  
Gonadotropin-Releasing Hormone Agonist - an overview | ScienceDirect Topics \[WWW Document\], n.d. URL [https://www.sciencedirect.com/topics/neuroscience/gonadotropin-releasing-hormone-agonist](https://www.sciencedirect.com/topics/neuroscience/gonadotropin-releasing-hormone-agonist?ref=thephysiohub.uk) (accessed 3.2.24).  
Jarrell, L., 2023\. Osteoporosis management in primary care. Nurse Pract 48, 11–20\. [https://doi.org/10.1097/01.NPR.0000000000000090](https://doi.org/10.1097/01.NPR.0000000000000090?ref=thephysiohub.uk)  
Overview | Osteoporosis: assessing the risk of fragility fracture | Guidance | NICE \[WWW Document\], 2012\. URL [https://www.nice.org.uk/guidance/cg146](https://www.nice.org.uk/guidance/cg146?ref=thephysiohub.uk) (accessed 3.2.24).  
Thiazolidinediones (glitazones) \[WWW Document\], n.d. . Diabetes UK. URL [https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/tablets-and-medication/thiazolidinediones-glitazones](https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/tablets-and-medication/thiazolidinediones-glitazones?ref=thephysiohub.uk) (accessed 3.2.24).  
Yang, R., Yu, Y., 2021\. Glucocorticoids are double-edged sword in the treatment of COVID-19 and cancers. Int J Biol Sci 17, 1530–1537\. [https://doi.org/10.7150/ijbs.58695](https://doi.org/10.7150/ijbs.58695?ref=thephysiohub.uk)