Understanding and managing secondary osteoporosis

ABSTRACT

Introduction: The term secondary osteoporosis (SO) identifies a reduction of bone mass related to a well-established disease or pharmacological agent. The identification of the underlying disease often represents a challenging situation in clinical practice.

Areas covered: The prevalence of SO in the real world may vary, ranging from 17% to 80%; therefore, search for a form of SO represents a pillar when evaluating patients with osteoporosis. Guidelines for treatment of specific secondary forms of osteoporosis, such as glucocorticoid-induced osteoporosis, have been published even though often neglected in clinical practice. For the majority of SO, there are currently no specific guidelines concerning treatment with only few trials showing the effect of bone-active drugs on fracture risk reduction.

Expert opinion: Healthcare professionals should be aware of the secondary forms of osteoporosis, in particular when the reason for reduced skeletal resistance is uncertain or when bone mineral density results are unsatisfactory in a patient compliant to therapy. In a few cases (such as, for example: no response to therapy, better classification of bone involvement in patients with kidney failure, suspicion of rare metabolic bone disease) bone biopsy is needed to investigate the patient. This review highlights recent advances in understanding and managing SO.

KEYWORDS:

• Secondary osteoporosis
• prevention
• treatment
• glucocorticoid-induced osteoporosis

Article highlights

• Secondary osteoporosis is not an uncommon condition

• There are conflicting data on the prevalence of secondary osteoporosis, being reported in 17–30% and 21–80% of women and men, respectively

• The skeleton is often an innocent bystander, negatively affected by diseases involving other organs

• Drug-induced osteoporosis are the most frequent causes of secondary osteoporosis; specific guidelines have been developed in the last decades on the management of patients receiving long-term treatment with these medications

• A comprehensive clinical evaluation of patients with osteoporosis is recommended to identify an underlying disorder

• Basal laboratory investigation is recommended in patients with osteoporosis; further workup should be requested based on clinical judgement

• Targeting the underlying disease is the best choice in patients with secondary osteoporosis

• Bone-active agents have been shown to increase BMD when prescribed to patients with secondary osteoporosis

• More data from intervention studies are needed concerning fracture end points

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.