The management of secondary osteoporosis.
Secondary osteoporosis is common among patients being evaluated for osteoporosis. All men and premenopausal women with unexplained bone loss or a history of a fragility fracture should undergo a work-up for secondary osteoporosis. Also, postmenopausal women with risk factors for secondary osteoporosis should be carefully evaluated. The evaluation should include a thorough history, physical examination, bone mineral density testing, and laboratory testing. While there is no consensus for a cost-effective laboratory evaluation, some recommendations include: 25-hydroxyvitamin D, parathyroid hormone (PTH), serum and urine calcium, phosphate, creatinine, liver function tests, a complete blood count, testosterone in men, and thyroid-stimulating hormone. After a thorough review of the evaluation for secondary osteoporosis, this chapter reviews the pathophysiology and treatment of secondary osteoporotic disorders, including vitamin D insufficiency, osteomalacia, the osteoporosis of erosive inflammatory arthritis, ankylosing spondylitis, systemic lupus erythematosus, and osteoporosis related to anti-androgenic therapy for prostate cancer and aromatase inhibitor therapy for breast cancer. Physicians have a significant responsibility to evaluate and treat the underlying medical problem that is the cause of secondary osteoporosis and to optimize bone health in the individual patient.
Kelman
Ariella
A
Division of Immunology and Rheumatology, Department of Medicine, Stanford University Medical Center, Stanford, CA 94304, USA.
Lane
Nancy E
NE
D000726:Androgen Antagonists / Q000009:adverse effects; D047072:Aromatase Inhibitors / Q000009:adverse effects; D001168:Arthritis / Q000150:complications; D015519:Bone Density; D019411:Clinical Laboratory Techniques; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008487:Medical History Taking; D010018:Osteomalacia / Q000150:complications; D010024:Osteoporosis / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D010808:Physical Examination; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000150:complications; D014808:Vitamin D Deficiency / Q000150:complications
D000726:Androgen Antagonists; D047072:Aromatase Inhibitors