REVIEWSecondary Causes of Osteoporosis
Section snippets
ESTIMATES OF THE INCIDENCE OF SECONDARY OSTEOPOROSIS
One of the challenges encountered in the discussion of secondary osteoporosis is understanding the problems of the disorder in the general population. Cost concerns have limited use of thorough work-ups to rule out all possible secondary causes, or studies may reflect experiences from subspecialty clinics or tertiary medical care centers where inherent bias may be present.
A small proportion of women with low trauma fractures have osteomalacia, and in men with femoral fractures, osteomalacia is
Glucocorticoids
Decalcification of the skeleton was recognized as a clinical feature of Cushing disease as early as 1932. Glucocorticoid excess results in diffuse bone loss and may affect trabecular bone more than cortical bone. Bone loss is due to suppression of osteoblast function, inhibition of intestinal calcium absorption leading to secondary hyperparathyroidism, and increased osteoclast-mediated bone resorption. Bone loss is also promoted by direct stimulation of renal excretion of calcium by
MISCELLANEOUS CAUSES OF SECONDARY OSTEOPOROSIS Eating Disorders
Anorexia nervosa and bulimia affect 5% to 10% of women.70 Onset may be at any time from adolescence through the fourth decade of life. These eating disorders are resistant to treatment and chronic in nature, which results in significant morbidity and mortality.
Anorexia nervosa has been associated with osteoporosis. There are several metabolic disorders associated with anorexia nervosa that may adversely affect the skeleton. These include estrogen deficiency, endogenous cortisol excess, reduced
DISEASES OF THE PANCREAS Pancreatic Insufficiency
Clinically significant bone disease in patients with pancreatic insufficiency due to cystic fibrosis or total pancreatectomy is not unusual. In children or young adults with cystic fibrosis, reduced bone density has been found and may be confounded by variables such as glucocorticoid use and hypogonadism.103,104 Clinical features include diabetes mellitus and steatorrhea. Steatorrhea probably has the most impact on vitamin D and calcium malabsorption. In a patient with bone disease secondary to
DISEASES OF THE LIVER
Liver diseases may cause bone disease because of the inability of the liver to convert vitamin D to 25-hydroxy-vitamin D. The role of vitamin D depends on hepatically produced vitamin D transport proteins, albumin, and vitamin D binding protein. The development of bone disease also depends on the transport of vitamin D metabolites to the target tissues, the degree to which enterohepatic circulation of vitamin D as metabolites contributes to the maintenance of bone, and the role of bile in
TRANSPLANTATION OSTEOPOROSIS
Organ transplantation has become an effective therapy for end-stage renal, hepatic, cardiac, and pulmonary disease.112 One-year patient survival is excellent, averaging 98% for living donor kidney, 87% for liver, and 85% for cardiac transplant recipients.113 Many patients now live for more than 10 years. Unfortunately, many transplant patients demonstrate a propensity to fracture, which greatly aggravates their quality of life. The pathogenesis of transplantation osteoporosis is incompletely
TARGETING INTERVENTIONS OF AN ASYMPTOMATIC PATIENT POPULATION
There is much controversy regarding the best work-up for patients who have been diagnosed as having osteoporosis based on BMD. The problem with attempting to apply strict diagnostic criteria regarding who may have a secondary or reversible cause of osteoporosis is that few data exist to provide adequate guidance. Most of the information that has been gathered has either been from subspecialty clinics, which would have an inherent bias (such as a rheumatology clinic where glucocorticoid
REFERENCES (148)
Osteoporosis in men
Endocrinol Metab Clin North Am
(1998)- et al.
Osteoporosis in men
Baillieres Clin Rheumatol
(1993) Glucocorticoid-induced osteoporosis
Baillieres Best Pract Res Clin Endocrinol Metab
(2000)- et al.
Inhibition of bone collagen synthesis by prostaglandin E2 in organ culture
Prostaglandins
(1974) In vitro studies of insulin-like growth factor I and bone
Growth Horm IGF Res
(2000)- et al.
Glucocorticoid-induced osteoporosis
Trends Endocrinol Metab
(2000) - et al.
Prevention of steroid-induced osteoporosis with (3-amino-1-hydroxypropylidene)-1, 1-bisphosphonate (APD)
Lancet
(1988) - et al.
Desferrioxamine therapy in hemodialysis patients with aluminum-associated bone disease
Kidney Int
(1989) - et al.
Effects of thyroid hormone on bone and mineral metabolism
Endocrinol Metab Clin North Am
(1990) - et al.
Variable bone mass recovery in hyperthyroid bone disease after radioiodine therapy in postmenopausal patients
Maturitas
(2000)
Emerging anabolic treatment for osteoporosis
Rheum Dis Clin North Am
Osteoblasts/stromal cells stimulate osteoclast activation through expression of osteoclast differentiation factor/RANKL but not macrophage colony-stimulating factor: receptor activator of NF-kappa B ligand
Bone
The biomechanical integrity of bone in experimental diabetes
Diabetes Res Clin Pract
Epidemiology and mortality of eating disorders
Psychiatr Clin North Am
Skeletal changes during space flight
Lancet
Effect of prolonged bed rest on bone mineral
Metabolism
Skeletal manifestations of the lymphomas and leukemias
Semin Roentgenol
Disease states affecting both liver and bone
Radiol Clin North Am
Metabolic bone disease after gastrectomy
Am J Med
Osteoporosis in a North American adult population with celiac disease
Am J Gastroenterol
Effect of gluten-free diet on bone mineral content in growing patients with celiac disease
Am J Clin Nutr
Bone recovery after a gluten-free diet: a 5-year follow-up study
Bone
Bone density and bone metabolism are normal after long-term gluten-free diet in young celiac patients
Am J Gastroenterol
Calcidiol and PTH levels in women attending an osteoporosis program
Calcif Tissue Int
Aetiology and presenting symptoms in male osteoporosis
Br J Rheumatol
Pathogenesis of vertebral crush fractures in women
J R Soc Med
Severe osteoporosis in men
Ann Intern Med
Use of oral corticosteroids and risk of fractures
J Bone Miner Res
Glucocorticoid-induced osteoporosis: summary of a workshop
J Clin Endocrinol Metab
Decreased bone mineral density during low dose glucocorticoid administration in a randomized, placebo controlled trial
J Rheumatol
Effects of inhaled glucocorticoids on bone density in premenopausal women
N Engl J Med
Fractures in rheumatoid arthritis: an evaluation of associated risk factors
J Rheumatol
Differential actions of prostaglandins in separate cell populations from fetal rat bone
Endocrinology
Alternate signaling pathways selectively regulate binding of insulin-like growth factor I and II on fetal rat bone cells
J Cell Biochem
Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids: potential mechanisms of their deleterious effects on bone
J Clin Invest
Apoptosis of osteocytes in glucocorticoid-induced osteonecrosis of the hip
J Clin Endocrinol Metab
Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update
Arthritis Rheum
Glucocorticoid-induced osteoporosis
Prevention of corticosteroid-induced osteoporosis with alendronate in sarcoid patients
Calcif Tissue Int
Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis
N Engl J Med
Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial
Arthritis Rheum
Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study
Arthritis Rheum
Osteomalacia with long-term anticonvulsant therapy in epilepsy
Br Med J
Altered calcium metabolism in epileptic children on anticonvulsants
Br Med J
Calcium metabolism in adult outpatients with epilepsy receiving long-term anticonvulsant therapy
Can Med Assoc J
Evidence of osteomalacia in an outpatient group of adult epileptics
Epilepsia
Absorption and biotransformation of cholecalciferol in drug-induced osteomalacia
J Clin Pharmacol
Phenobarbital-induced alterations in vitamin D metabolism
J Clin Invest
A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy
Q J Med
Drug-induced osteomalacia
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