Approach to the patient with secondary osteoporosis

Eur J Endocrinol. 2010 Jun;162(6):1009-20. doi: 10.1530/EJE-10-0015. Epub 2010 Mar 15.


Secondary osteoporosis is characterized by low bone mass with microarchitectural alterations in bone leading to fragility fractures in the presence of an underlying disease or medication. Scenarios that are highly suspicious for secondary osteoporosis include fragility fractures in younger men or premenopausal women, very low bone mineral density (BMD) values, and fractures despite anti-osteoporotic therapy. An open-minded approach with a detailed history and physical examination combined with first-line laboratory tests are aimed at identifying clinical risk factors for fractures, osteoporosis-inducing drugs, and underlying endocrine, gastrointestinal, hematologic, or rheumatic diseases, which then need to be confirmed by specific and/or more invasive tests. BMD should be assessed with bone densitometry at the hip and spine. Lateral X-rays of the thoracic and lumbar spine should be performed to identify or exclude prevalent vertebral fractures which may be clinically silent. Management of secondary osteoporosis includes treatment of the underlying disease, modification of medications known to affect the skeleton, and specific anti-osteoporotic therapy. Calcium and vitamin D supplementation should be initiated with doses that result in normocalcemia and serum 25-hydroxyvitamin D concentrations of at least 30 ng/ml. Oral and i.v. bisphosphonates are effective and safe drugs for most forms of secondary osteoporosis. Severe osteoporosis may require the use of teriparatide.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bone Density / physiology
  • Bone Density Conservation Agents / therapeutic use
  • Endocrine System Diseases / complications*
  • Female
  • Gastrointestinal Diseases / complications*
  • Humans
  • Male
  • Osteoporosis / diagnosis*
  • Osteoporosis / etiology
  • Osteoporosis / therapy*


  • Bone Density Conservation Agents