Secondary Osteoporosis

What Is Secondary Osteoporosis?

Secondary osteoporosis is the loss of bone density and a related increased fracture risk that occurs as a result of an underlying medical condition or the use of certain medications. Unlike primary osteoporosis, secondary osteoporosis has an identifiable cause. Various diseases that disrupt the body’s balance or long-term medication use can negatively influence the processes of bone formation and breakdown, thus promoting bone loss. This condition can occur at any age, but its progression may vary depending on the type and duration of the underlying cause.

What Are the Causes of Secondary Osteoporosis?

Numerous factors play a role in the development of secondary osteoporosis. These factors can generally affect the body’s hormonal balance, nutrient absorption, or directly influence the activity of bone cells:

Endocrine Disorders: Hormonal imbalances such as an overactive thyroid or parathyroid glands (hyperthyroidism, hyperparathyroidism), Cushing’s syndrome, and diabetes (sugar disease) can negatively impact bone health. These conditions can accelerate bone breakdown or slow down bone formation.
Gastrointestinal Diseases: Chronic bowel diseases like celiac disease, Crohn’s disease, and ulcerative colitis can impair nutrient absorption, leading to an insufficient supply of essential substances for bone health, such as calcium and vitamin D. Certain stomach surgeries can also cause similar problems.
Rheumatological Diseases: Chronic inflammatory diseases such as rheumatoid arthritis and ankylosing spondylitis (Morbus Bechterew) can trigger bone loss due to persistent inflammation in the body.
Hematological Diseases: Some blood disorders, such as multiple myeloma and leukemia, can directly affect the bone marrow and increase bone breakdown.
Kidney Diseases: Chronic kidney failure can influence bone metabolism by disrupting vitamin D activation and negatively affecting calcium balance.
Certain Medications: The long-term use of corticosteroids (like prednisone), some anticonvulsants (epilepsy medications), proton pump inhibitors (stomach protectors), aromatase inhibitors (medications used in breast cancer treatment), and excessive use of thyroid hormones can reduce bone density.
Other Conditions: Prolonged bed rest, certain medications used after organ transplantation, and eating disorders (like anorexia nervosa) can also contribute to secondary osteoporosis.

What Are the Symptoms of Secondary Osteoporosis?

The symptoms of secondary osteoporosis can often develop insidiously, similar to primary osteoporosis, and clear signs may not appear until bone density has significantly decreased. Therefore, the symptoms of the underlying disease or medication use may be more prominent. However, as bone loss progresses, the following conditions may be observed:

Bone Fractures: The unexpected occurrence of fractures, especially as a result of minor trauma or falls, can be the first sign of secondary osteoporosis. The spine, hip, and wrist are the most commonly affected areas.
Back Pain: Strong back pain can occur, particularly as a result of vertebral fractures.
Loss of Height: Repeated vertebral compression fractures can lead to a gradual loss of height over time.
Hunchback (Kyphosis): A curvature of the back and a hunchback can develop as a result of vertebral fractures and collapses.

In secondary osteoporosis, the specific symptoms of the underlying disease may also accompany it. For example, a person with hyperthyroidism may also experience symptoms such as nervousness, weight loss, and palpitations.

How Is Secondary Osteoporosis Diagnosed?

The diagnosis of secondary osteoporosis begins with bone density measurement, similar to primary osteoporosis, but also includes additional assessments to determine the underlying cause:

Bone Density Measurement (DXA – Dual-energy X-ray Absorptiometry): This test is the primary tool for measuring bone mineral density to determine the presence and severity of osteoporosis. Measurements are typically taken from the hip and spine.
Physical Examination and Detailed Medical History: Uzm. Dr. Burcu Meryem Atak Sançmış assesses her patients not only based on their current complaints but from a holistic health perspective. In addition to the physical examination, all medical data such as previous illnesses, medications used, family history, and lifestyle are carefully considered. In this way, all possible causes that could influence bone health are analyzed with scientific accuracy, and an individual treatment plan is created.
Blood and Urine Tests: Various blood and urine tests can be performed to investigate possible causes of secondary osteoporosis. These tests can evaluate hormone levels (thyroid, parathyroid, sex hormones), calcium and phosphorus levels, kidney functions, inflammation markers, and some indicators of bone metabolism.
Radiological Imaging: X-rays can be helpful in detecting bone fractures or spinal abnormalities. If necessary, advanced imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) may also be used.
Bone Biopsy: In rare cases, a bone marrow sample may be taken and examined under a microscope to determine the underlying cause. This may be necessary, especially when hematological diseases or metabolic bone diseases are suspected.

How Is Secondary Osteoporosis Treated?

The treatment of secondary osteoporosis is similar to the approaches for treating primary osteoporosis, but primarily focuses on treating the underlying cause:

Treatment of the Underlying Cause: Managing the medical condition or medication use that forms the basis of secondary osteoporosis is crucial to stop or slow down bone loss. For example, hyperthyroidism should be treated, and, if possible, the dose of medications that negatively affect bone density should be adjusted or alternatives evaluated.
Lifestyle Changes: As with primary osteoporosis, adequate intake of calcium (1000-1200 mg daily) and vitamin D (800-1200 IU daily), regular weight-bearing and muscle-strengthening exercises, avoidance of smoking and excessive alcohol consumption, and fall prevention measures are also important in the management of secondary osteoporosis.
Medication Therapy: Uzm. Dr. Burcu Meryem Atak Sançmış plans the most suitable medication therapy based on the patient’s general condition and the underlying causes. For secondary osteoporosis, medications such as bisphosphonates, denosumab, teriparatide, and romosozumab are evaluated individually as needed.
Follow-up and Monitoring: Regular bone density measurements (DXA) and follow-up examinations are important to assess the effectiveness of the treatment and adjust the treatment plan if necessary. The course of the underlying disease should also be closely monitored.

The treatment of secondary osteoporosis may require collaboration between different specialties depending on the nature of the underlying cause. Endocrinologist Uzm. Dr. Burcu Meryem Atak Sançmış coordinates with relevant specialists when necessary to plan the optimal treatment course for her patients.

Frequently Asked Questions

What health problems can cause secondary osteoporosis, distinct from bone loss seen in postmenopausal women?

Various medical conditions such as thyroid or parathyroid diseases, intestinal problems, kidney disorders, and the long-term use of certain medications can be the cause of secondary osteoporosis. Bone loss after menopause, however, is associated with hormonal changes.

What nutritional aspects are important to protect against bone loss (osteoporosis)?

For both primary and secondary osteoporosis, it’s important to consume foods rich in calcium and vitamin D (dairy products, green leafy vegetables, fatty fish). However, for secondary osteoporosis, specific dietary recommendations related to the underlying disease may also be relevant.

How can I tell if I have secondary osteoporosis?

There are usually no obvious symptoms. The diagnosis is made through a bone density measurement (DXA). In secondary osteoporosis, the symptoms of the underlying disease can also be indicative. Fractures can be the first sign.

Are supplements used for bone loss (osteoporosis) also effective in secondary osteoporosis?

Uzm. Dr. Burcu Meryem Atak Sançmış evaluates the use of calcium and vitamin D supplements in the treatment of secondary osteoporosis according to the patient’s individual needs. However, the main focus is on correctly identifying and effectively treating the underlying cause of bone loss.

Can bones damaged by secondary osteoporosis regain strength?

Bone loss can be slowed, and bone density can be increased to some extent through medication therapy and lifestyle changes. Controlling the underlying cause plays a critical role in the healing process. Complete restoration may not be possible.

At what ages is secondary bone loss (osteoporosis) most commonly seen?

It can occur at any age, depending on the underlying disease or medication use. For example, the risk is increased in individuals using long-term corticosteroids or those with chronic kidney disease.

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