Osteoporosis secondary

Clinical stresses which interfere with vitamin metabohsm, can result in calcium deficiency leading to osteomalacia and osteoporosis (secondary vitamin D deficiency). These stresses include intestinal malabsorption (lack of bile salts) stomach bypass surgery obstmctive jaundice alcoholism Hver or kidney failure decreasing hydroxylation of vitamin to active forms inborn error of metabohsm and use of anticonverdiants that may lead to increased requirement. 

GI tract obstruction, hyperchloremic acidosis, and osteoporosis secondary to calcium excretion may occur. 

NICE (National Institute for Health and Clinical Excellence) (2008). Osteoporosis -Secondary prevention including strontium ranelate. Available at http //www.nice. org.uk/guidance/TA161/guidance/pdf/English/ [Accessed 4 July 2008],... 

It has been shown that in postmenopausal women habitually high intakes of dietary isoflavones are associated with higher bone mineral density (BMD) values at both the spine and hip region (Mei et al, 2001). It is conceivable that an isoflavone-rich diet may help to reverse the state of secondary hyperparathyroidism associated with estrogen withdrawal and hence lower the rate of bone turnover in postmenopausal women, thus reducing the risk of osteoporosis (Valtuena et al, 2003). Phytoestrogens could be used as natural SERMs (Brzezinski and Debi, 1999) and some studies (Setchell, 2001 and refs therein) support such an idea since the molecular targets of... 

Osteoporosis can be classified as either primary (no known cause) or secondary (caused by drugs or other diseases). Primary osteoporosis is found most often in postmenopausal women and aging men, but it can occur in other age groups as well. 

Osteoporosis also can develop from secondary causes such as concurrent disease states and drugs (Table 53-2). 

Approximately one-third to one-half of osteoporosis cases in men and half of all cases in perimenopausal women are due to secondary causes.4 Common secondary causes in men include hypogonadism, glucocorticoid use, and alcoholism. The most common cause of drug-induced osteoporosis is glucocorticoid use. 

Only useful to rule out secondary causes of osteoporosis Diagnostic Tests... 

Because secondary osteoporosis causes play a significant role in men, any secondary cause (e.g., hypogonadism) should be excluded or treated before considering other drug therapy. 

Assess patient risk factors for osteoporosis, with special attention to age, menopausal status, previous history of osteoporotic fracture, smoking status, low body weight, family history of osteoporotic fracture in first-degree relatives, and presence of secondary causes of osteoporosis. 

Categories of osteoporosis include (1) postmenopausal osteoporosis, (2) age-related osteoporosis, and (3) secondary osteoporosis. 

Calcium should be ingested in adequate amounts to prevent secondary hyperparathyroidism and bone destruction. Although calcium increases BMD, fracture prevention is minimal. It should be combined with vitamin D and osteoporosis medications when needed. 

This drug class has an enormous potential in the primary and secondary prevention of several types of estrogen-dependent tumors, postmenopausal osteoporosis, and cardiovascular and neurodegenerative diseases. 

Primary osteoporosis is the most common form of the condition. The secondary form of osteoporosis is diagnosed when an illness and/or medications are present with a negative impact on BMD. Examples of common chronic conditions in old people that can cause secondary osteoporosis are seen in Box 5.14. Examples of drugs that can cause secondary osteoporosis are glucocorticoids, too high doses of thyroid hormone, anticonvulsants, and heparin. Especially the use of glucocorticoids has been known to cause severe osteoporosis even within a short period of treatment. Depending on the doses the development of osteoporosis can occur within a few weeks or months. 

Box 5.14 Examples of conditions that can cause secondary osteoporosis... 

Malnutrition can also cause secondary osteoporosis in persons with different deficiencies of substances such as calcium and vitamin D. Malnutrition due to starvation caused by most severe or terminal chronic diseases and malabsorption due to inflammatory bowel diseases (colitis, Mb Crohn) can give rise to rapidly diminishing bone tissue. 

These results indicated osteoporosis. In this condition, which often appears secondary to another pathology such as an endocrinopathy, chronic renal failure or following long term immobilization, bone architecture is normal hut its mass is reduced relative to its volume, that is there is normal mineralization hut the amount of osteoid matrix is reduced. Treatment is with bone resorption inhibitors such as the bisphosphonate group of drugs, for example alendronate. 

Menkes disease Deficient cross-linking secondary to functional copper deficiency Depigmented (steely) hair Arterial tortuosity, rupture Cerebral degeneration Osteoporosis, anemia... 

Qassification Idiopathic osteoporosis type 1, occurring in postmenopausal females type 11, occurring in senescent males and females (>70 y). Secondary osteoporosis associated with primary disorders such as Cushing s disease, or induced by drugs, e.g chronic therapy with glucocorticoids or heparin. In these forms, the cause can be eliminated. 

Osteoporosis is a metabolic bone disease characterized by low bone mass and micro-architectural deterioration of bone tissue. This will lead to bone fragility and consequent increase in bone fracture risk. Mean bone mineral density (BMD) is measured with dual X-ray absorptiometry (DEXA) and expressed in Tsc (Tscore). WHO standards are a Tsc that is 1 standard deviation (SD) below mean BMD is graded as normal bone, Tsc between 1 and 1.5 SD below mean BMD is graded as osteopenia and a Tsc of more than 2.5 SD below mean BMD is graded as osteoporosis. When the Tsc is below 1.5 SD mean BMD prevention of osteoporosis must be initiated. Primary osteoporosis is caused mainly by hormone deflciency in both women and men. Secondary osteoporosis may result from endocrine, metabolic, nutritional and autoimmune causes or from immobility because of trauma. Also the use of medicaments such as corticosteroids may be contributing. 

In the treatment of secondary adrenocortical insufficiency, lower doses of cortisol are generally effective, and fluid and electrolyte disturbances do not have to be considered, since patients with deficient corticotrophin secretion generally do not have abnormal function of the zona glomerulosa. Since cortisol replacement therapy is required for life, adequate assessment of patients is critical to avoid the serious long-term consequences of excessive or insufficient treatment. In many cases, the doses of glucocorticoid used in replacement therapy are probably too high. Patients should ideally be administered three or more doses daily. To limit the risk of osteoporosis, replacement therapy should be carefully assessed on an individual basis and overtreatment avoided. 

Contraindications Primary or secondary hyperparathyroidism, including hypercalci-uria (renal calcium leak), hypomagnesemic states (serum magnesium less than 1.5 mg/dl), bone disease (osteoporosis, osteomalacia, osteitis), hypocalcemic states (e.g., hypoparathyroidism, intestinal malabsorption), normal or low intestinal absorption and renal excretion of calcium, enteric hyperoxaluria, and patients with high fasting urinary calcium or hypophosphatemia. 

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