An Overview of Secondary Osteoporosis

Secondary osteoporosis is caused by certain diseases and treatments that interfere with bone density and cause bone loss. Research from the Journal of Osteoporosis shows that secondary osteoporosis affects at least 21% of men and 17.5% of women.

While the treatment for secondary osteoporosis involves addressing the underlying medical condition or treatment causing these changes, various methods can help with reducing bone loss, strengthening bones, and preventing fractures. 

Symptoms

People with osteoporosis generally do not experience symptoms. Most of the time, osteoporosis goes undetected for many years and is not diagnosed until a person breaks a bone. Common bone fractures related to osteoporosis include fractures of the hip, wrist, or spine. Occasionally, osteoporosis will cause symptoms related to gradual collapse of the weakened bones in the spine. These may include:

• Backache due to compression fractures in the spine
• A stooped posture where the upper back becomes curved (called kyphosis)
• Gradual height loss

Back pain can be common with osteoporosis of the spine. Pain is localized and increases with lifting. Tenderness in the affected area is also common. Pain and tenderness can persist for long periods.

Causes

A number of medical conditions, medications, and lifestyle factors can cause secondary osteoporosis. Common medical disorders that contribute to secondary osteoporosis are endocrine or hormonal imbalance conditions (such as hyperthyroidism, a condition that causes excessive thyroid function).

Chronic kidney or liver diseases can also cause secondary osteoporosis, as can rheumatoid arthritis, a chronic autoimmune disease that causes severe inflammation of the joints, tissues, and organs throughout the body. Eating disorders can also cause secondary osteoporosis.

Medications that may contribute to the development of secondary osteoporosis include:

• Corticosteroids. These medications treat a variety of conditions and have been long known to cause bone loss.
• Hormone treatments.
• Lithium. Drugs with lithium are commonly used to treat bipolar disorder.
• Chemotherapy treatments.

Some lifestyle factors may also contribute to secondary osteoporosis, including excessive alcohol consumption, smoking, and not eating enough foods rich in vitamin D and calcium.

Diagnosis

Secondary osteoporosis is diagnosed using the same tests as with primary osteoporosis. Testing includes:

• Bone density testing: A bone densitometry (DEXA) test is the most accurate method for diagnosing osteoporosis. DEXA scanning uses low energy X-rays through a bone (spine, hip, or wrist) to determine bone mineral density, which can indicate the severity of osteoporosis and the probability of fractures. The test is short, painless, and there is limited radiation exposure.
• Bloodwork: This is done to measure calcium, phosphorus, alkaline phosphatase, creatinine and vitamin D levels. Abnormal and low levels may indicate treatable causes for developing osteoporosis. In men, testosterone serum testing may be included as well.
• X-rays: X-rays, particularly of the spine, can be helpful to diagnosis an osteoporotic vertebral fracture in people who are symptomatic or at high risk.

Treatment

Much like primary osteoporosis, there is no cure for secondary osteoporosis. Treatment for secondary osteoporosis can be a little more complex and depends on the underlying condition. 

Treatment of secondary osteoporosis is also aimed at preventing bone loss, fractures, and disability as well as controlling pain. Your osteoporosis treatment plan may include lifestyle changes and medications. 

Lifestyle

The following lifestyle changes can help you to manage osteoporosis and reduce your risk of fractures.

Diet

Healthcare providers recommend getting plenty of vitamin D and calcium from your diet. Calcium is the primary mineral in the bones while vitamin D helps the body absorb the calcium it needs for optimal health and strong bones. Maintaining adequate intake of vitamin D and calcium can slow down bone loss. When bone loss is slowed, the risk for fractures is reduced.  

Calcium-rich foods to add to your diet include:

• Dairy
• Enriched breads and grains
• Dark green vegetables
• Soy products     
• Calcium-fortified juices and cereals

The NIH Osteoporosis and Related Bone Diseases - National Resource Center recommends adult men and women get 1,000 milligrams (mg) of calcium daily. Women between ages 51 and 70 and everyone over 70 should get 1,200 mg of calcium per daily. The NIH further recommends that adults under 70 get 600 international units (IU) of vitamin D daily. Vitamin D-rich foods include saltwater fish, fortified milk, liver, and egg yolks. 

If you cannot get enough vitamin D or calcium from your diet, your healthcare provider can suggest supplements to help you get the recommended amounts.

Exercise

Physical activity, regardless of the type, may benefit those with osteoporosis. It can improve posture and balance and reduce the risk of falling, which means it reduces the chance of more fractures. It may have some effect on bone density as well.

Strength training can help make your arms and spine stronger and can include anything from weight machines to resistance bands and free weights. Weight-bearing exercises such as walking, as well as low-impact aerobics such as biking can strengthen the bones in your hips, lower spine, and legs. Check with your healthcare provider before beginning any new exercise program.

Reverse Bad Habits

In addition to all the health problems that smoking and overconsumption of alcohol can cause, they also affect your bone health. Cigarette smoking can interfere with bone formation and increase the risk of bone loss. Alcohol can have similar effects. You should avoid smoking altogether and drink in moderation.

Medications 

Medications for treating osteoporosis are designed to decrease bone loss. Bisphosphonates are the most commonly prescribed medications for treating osteoporosis. Popular bisphosphonates include:

• Fosamax (alendronate)
• Actonel (risedronate)
• Reclast (zoledronic acid)            
• Boniva (ibandronate)

Additional medications for treating secondary osteoporosis include:

• Prolia. Prolia (denosumab) is an alternative to bisphosphonates for people who cannot take these medications. Research shows it can improve bone mineral density and reduce fracture risk. 
• Forteo. Forteo (teriparatide) injections are commonly prescribed to people who have had fractures and whose osteoporosis is caused by corticosteroid use. This medication may help rebuild bone.  
• Hormone replacement therapy (HRT). HRT or estrogen has been shown to prevent bone loss and fractures and increase bone density.  It is generally prescribed for women who are post-menopausal.  It is available as a patch or a pill. HRT is not recommended for long-term treatment of osteoporosis due to its adverse effects, including increased risks for heart attack, strokes, blood clots, and breast cancer. Women should talk to their healthcare providers about whether HRT is an option for treating their osteoporosis and whether the benefits of HRT would outweigh the risks.

Summary

Osteoporosis is a common condition and while there isn’t a cure, treatments are available. Medications, hormone therapies, and lifestyle changes can help to slow done bone loss and make your bones stronger. If you think you may have secondary osteoporosis, talk to your healthcare provider about the best treatments for your unique situation. With help from your practitioner, you can find the right treatment plan and reduce your risk for fractures.