Osteoporosis

Published on 10/03/2015 by admin

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Last modified 10/03/2015

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Chapter 25 OSTEOPOROSIS

Theodore O’Connell

Primary osteoporosis results from deterioration of bone mass that is related to aging and decreased gonadal function but is not associated with any chronic illness. Because primary osteoporosis results from decreased gonadal function, early menopause or premenopausal estrogen deficiency may hasten the development of osteoporosis in women. Other risk factors for primary osteoporosis include female gender in general, white or Asian ancestry, sedentary lifestyle, tobacco use, low calcium intake, and low body weight.

Secondary osteoporosis results from chronic conditions that contribute to accelerated loss of bone density. Chronic conditions that may contribute to secondary osteoporosis include acromegaly, alcoholism, anorexia nervosa, chronic liver disease, diabetes mellitus type I, glycogen storage diseases, hemochromatosis, homocystinuria, hyperadrenocorticism, hyperparathyroidism, hyperprolactinemia, hypophosphatasia, malabsorption syndromes and gastric bypass surgery, Marfan syndrome, osteogenesis imperfecta, renal disease, thyrotoxicosis, and vitamin D deficiency.

Men are more likely than women to have a secondary cause of osteoporosis. In the patient with osteoporosis, initial evaluation should begin with a risk factor assessment (see risk factors listed later in this chapter), documentation of history, and a physical examination focusing on signs of chronic disease. If secondary osteoporosis is suspected on the basis of findings from the history and physical examination, a work-up should be performed.

Long-term glucocorticoid therapy is a common cause of osteoporosis. Medications that may cause osteoporosis are listed below.

Medications Associated with Osteoporosis

Glucocorticoids

Gonadotropin-releasing hormone (GnRH) agonists

Heparin (prolonged treatment)

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