Abstract
A general knowledge of secondary causes of bone loss and osteoporosis is useful and necessary in the practice of densitometry. It must be remembered that the bone density study provides information on the density of the bone at that moment only. It does not, by itself, identify any magnitude of bone loss and certainly cannot be used to identify the cause of any suspected bone loss. It is a single snapshot in time, telling the physician what the bone density is that day, but not how or why it got that way. Because of this, any time that the bone density is classified as low or osteoporotic, an evaluation of the patient for secondary causes of bone loss is appropriate. This evaluation would be performed by the patient’s treating physician, and the extent of the evaluation would be guided by his or her knowledge of the patient. If the patient is well known to the physician, a review of the patient’s medical records may be all that is warranted. It is also possible that additional testing or inquiry may be necessary to exclude causes of bone loss and conditions other than postmenopausal or age-related osteoporosis, as specific interventions may be necessary for successful treatment. Even if the densitometrist is not the treating physician, he or she may still be called upon to render an opinion as to the possible differential diagnoses for suspected bone loss and any appropriate evaluations necessary to exclude those possibilities. The International Society for Clinical Densitometry (ISCD) recommended in 2003 (1) that bone density reports contain a reminder to the referring physician that a “medical evaluation for secondary causes of low BMD may be appropriate.” Specific recommendations regarding the nature of such an evaluation were considered optional. The ability to make specific recommendations, however, is desirable and often necessary in order to assist the referring physician.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
See Chapter 3 for a discussion of the z-score.
- 2.
Strictly speaking, the range is from ––1.96 to +1.96; however, this is generally rounded to ––2 to +2.
- 3.
See Chapter 1 for a discussion of the older techniques of single- and dual-photon absorptiometry.
- 4.
To convert nmol/L to ng/ml, multiply the nmol/L value by 2.496.
- 5.
Looser’s zones (pseudo-fractures) are focal accumulations of osteoid, which occur in cortical bone perpendicular to the long axis of the bone. They may be bilateral and symmetrical.
- 6.
See Chapter 2 for a discussion of naming conventions for radial and forearm sites.
References
Indications and reporting for dual-energy x-ray absorptiometry. J Clin Densitom 2004;7(1):37–44.
Tannenbaum C, Clark J, Schwartzman K et al. Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J Clin Endocrinol Metab 2002;87(10)4431–4437.
Johnson BE, Lucasey B, Robinson RG, Lukert BP. Contributing diagnoses in osteoporosis. The value of a complete medical evaluation. Arch Intern Med 1989;149(5)1069–1072.
Brown JP, Ioannidis G, Adachi JD et al. Secondary causes of osteoporosis in patients registered in the Canadian Database of Osteoporosis and Osteopenia (CANDOO). J Bone Miner Res 2002;17:S261.
Freitag A, Barzel US. Differential diagnosis of osteoporosis. Gerontology 2002;48(2)98–102.
Haden ST, Fuleihan GE, Angell JE, Cotran NM, LeBoff MS. Calcidiol and PTH levels in women attending an osteoporosis program. Calcif Tissue Int 1999;64(4)275–279.
Deutschmann HA, Weger M, Weger W, Kotanko P, Deutschmann MJ, Skrabal F. Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J Intern Med 2002;252(5)389–397.
National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. 1–30. 2008. Washington, D.C., National Osteoporosis Foundation.
Personal communication from Marjorie M. Luckey.
Hodgson SF, Watts NB, Bilezikian JP et al. American Association of Clinical Endocrinologists 2001 Medical Guidelines for Clinical Practice for the Prevention and Management of Postmenopausal Osteoporosis. Endocr Pract 2001;7(4)293–312.
Hodgson SF, Watts NB, Bilezikian JP et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 2003;9(6)544–564.
Wagman, RB, Marcus R. Beyond bone mineral density—navigating the laboratory assessment of patients with osteoporosis. J Clin Endocrinol Metab 2002;87(10)4429–4430.
Jamal SA, Leiter RE, Bayoumi AM, Bauer DC, Cummings SR. Clinical utility of laboratory testing in women with osteoporosis. Osteoporos Int 2005;16(5)534–540.
Black DM, Reiss TF, Nevitt MC, Cauley J, Darpf D, Cummings SR. Design of the Fracture Intervention Trial. Osteoporos Int 1993;S3:S29–S39.
WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO, editor. [843], 1–129. 1994. Geneva. WHO Technical Report Series.
Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause 2006;13(3)340–367.
Lewiecki EM. Nonresponders to osteoporosis therapy. J Clin Densitom 2003;6(4)307–314.
Ebeling PR. Clinical practice. Osteoporosis in men. N Engl J Med 2008;358(14)1474–1482.
Campion JM, Maricic MJ. Osteoporosis in men. Am Fam Physician 2003;67(7)1521–1526.
Tuck S, Francis R. Osteoporosis in men. In: Arden N, editor. Osteoporosis. London: Remedica; 2006; 163–;183.
Orwoll ES. The clinical evaluation of osteoporosis in men. In: Orwoll ES, editor. Osteoporosis in Men: The Effects of Gender on Skeletal Health. San Diego: Academic Press; 1999;527–552.
Parfitt AM. Osteomalacia and related disorders. In: Avioli LV, Krane SM, editors. Metabolic bone disease and clinically related disorders. 2nd ed. Philadelphia: WB Saunders; 1990;329–396.
Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for calcium, magnesium, phosphorus, vitamin D, and fluoride. 1997. Washington, D.C., National Academy Press.
Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 2004;80(6 Suppl):1706S–1709S.
Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int 2005;16(7)713–716.
Holick MF, Siris ES, Binkley N et al. Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005;90(6)3215–3224.
Binkley N, Novotny R, Krueger D et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 2007;92(6)2130–2135.
Chapuy MC, Preziosi P, Maamer M et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997;7(5)439–443.
Simonelli C, Weiss TW, Morancey J, Swanson L, Chen YT. Prevalence of vitamin D inadequacy in a minimal trauma fracture population. Curr Med Res Opin 2005;21(7)1069–1074.
Geller JL, Hu B, Reed S, Mirocha J, Adams JS. Increase in bone mass after correction of vitamin D insufficiency in bisphosphonate-treated patients. Endocr Pract 2008;14(3)293–297.
Deane A, Constancio L, Fogelman I, Hampson G. The impact of vitamin D status on changes in bone mineral density during treatment with bisphosphonates and after discontinuation following long-term use in post-menopausal osteoporosis. BMC Musculoskelet Disord 2007;8:3.
Adami S, Giannini S, Bianchi G et al. Vitamin D status and response to treatment in post-menopausal osteoporosis. Osteoporos Int 2008;doi. 10.1007/s00198-008-0650-y.
Binkley N, Krueger D, Cowgill CS et al. Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 2004;89(7)3152–3157.
Carter GD, Carter R, Jones J, Berry J. How accurate are assays for 25-hydroxyvitamin D? Data from the international vitamin D external quality assessment scheme. Clin Chem 2004;50(11)2195–2197.
Hollis BW. Editorial: The determination of circulating 25-hydroxyvitamin D: no easy task. J Clin Endocrinol Metab 2004;89(7)3149–3151.
Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 2004;89(11)5387–5391.
Disorders of mineral metabolism. In: Beers E, Berkow R, editors. The Merck Manual of Geriatrics. 3rd ed. Whitehouse Station: Merck Research Laboratories,2000;572–583.
Larsson L, Magnusson P. Ionized calcium or corrected total calcium? J Bone Miner Res 2003;18(8)1554–1555.
Heaney RP, Recker RR, Ryan RA. Urinary calcium in perimenopausal women: normative values. Osteoporos Int 1999;9(1)13–18.
Steinbach HL, Noetzli M. Roentgen appearance of the skeleton in osteomalacia and rickets. Am J Radiol 1964;91:955.
Bilezikian JP, Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism. N Engl J Med 2004;350(17)1746–1751.
Bilezikian JP, Potts JT, Jr., Fuleihan G et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 2002;87(12)5353–5361.
Green PH, Cellier C. Celiac disease. N Engl J Med 2007;357(17)1731–1743.
Fasano A, Berti I, Gerarduzzi T et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003;163(3)286–292.
Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 2006;131(6)1981–2002.
Vitoria JC, Arrieta A, Arranz C et al. Antibodies to gliadin, endomysium, and tissue transglutaminase for the diagnosis of celiac disease. J Pediatr Gastroenterol Nutr 1999;29(5)571–574.
AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease. Gastroenterology 2006;131(6)1977–1980.
Fitzpatrick LA. Secondary causes of osteoporosis. Mayo Clin Proc 2002;77(5)453–468.
Alto WA, Clarcq L. Cutaneous and systemic manifestations of mastocytosis. Am Fam Physician 1999;59(11)3047–3060.
Rajkumar SV, Kyle RA. Multiple myeloma: diagnosis and treatment. Mayo Clin Proc 2005;80(10)1371–1382.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2010 Humana Press, a part of Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Bonnick, S.L. (2010). Secondary Causes of Osteoporosis. In: Bone Densitometry in Clinical Practice. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-499-9_12
Download citation
DOI: https://doi.org/10.1007/978-1-60327-499-9_12
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-60327-498-2
Online ISBN: 978-1-60327-499-9
eBook Packages: MedicineMedicine (R0)