Causes of Secondary Osteoporosis

Where someone develops osteoporosis mainly because of another medical condition this is referred to as secondary osteoporosis. This is common, although the likelihood of a secondary cause varies significantly with age, with estimates of up to 30% for postmenopausal women and over 50% for men.

Identifying secondary osteoporosis in patients with high-risk conditions allows for timely intervention and appropriate specialist referral.

Please review the past medical history including problem lists on clinical letters to identify any of the High-Risk Conditions below which are strongly linked to secondary osteoporosis:

• Rheumatoid arthritis and other chronic inflammatory arthritis
• Gastrointestinal malabsorption, including coeliac disease, Crohn’s disease and “short bowel” due to surgery (not colectomy)
• Long term untreated endocrine problems – hyperthyroidism, hyperparathyroidism, Cushing’s syndrome
• Hypogonadism in men, premature menopause in women <45 years including due to surgery
• Myeloma and monoclonal gammopathy of uncertain significance (MGUS)
• Low body weight from any cause (including a past or current eating disorder)
• Drugs which cause significant bone loss:
  • Long-term treatment with glucocorticoids (>3 months)
  • Excess thyroid hormone replacement
  • Aromatase inhibitors (letrozole, anastrozole)
  • Anti-androgen therapy and GnRH agonists (cyproterone, flutamide, bicalutamide, goserelin)

If any of these are present and you would not already be recommending treatment, please discuss with your local Osteoporosis Clinical Lead whether investigation or treatment is indicated at a lower threshold than you would usually apply. You should also discuss whether to refer to other specialist services if these conditions are not being actively managed by a relevant service.