Causes of Osteoporosis
Caucasian and Asian women are at highest risk of developing osteoporosis. African-American and Hispanic women have a lower, but still significant, risk. Osteoporosis and risk for fractures may be due, in part, to heredity. People whose parents have a history of fractures also seem to have reduced bone mass and may be at risk for fractures.
The loss of bone mass can also be caused by certain lifestyle factors, diseases, or medications. The majority of people with osteoporosis have at least one secondary cause.
These additional causes of secondary osteoporosis include:
- Glucocorticoid medications
- Other immunosuppressive drugs
- Hypogonadism (low testosterone levels)
- Excessive alcohol consumption
- Chronic obstructive pulmonary disease and asthma
- Cystic fibrosis
- Gastrointestinal disease
- Anticonvulsant medications
- Osteogenesis imperfecta
- Neoplastic disease
- Ankylosing spondylitis and rheumatoid arthritis
- Systemic mastocytosis.
Glucocorticoids are steroid medications used to treat diseases such as asthma and rheumatoid arthritis. Bone loss is a common side effect of these medications. This may be due to the medications' direct effect on bone, muscle weakness or immobility, reduced intestinal absorption of calcium, a decrease in testosterone levels, or, most likely, a combination of these factors.
When glucocorticoid medications are used on an ongoing basis, bone mass often decreases quickly and continuously, with most of the bone loss occurring in the ribs and vertebrae. Therefore, people taking these medications should talk to their healthcare provider about having a bone mineral density (BMD) test. Men should also be tested to monitor testosterone levels, as glucocorticoids often reduce testosterone in the blood.
A treatment plan to minimize bone loss during long-term glucocorticoid therapy may include using the minimal effective dose, discontinuing the drug, or administering it through the skin, if possible. Adequate calcium and vitamin D intake is important, as these nutrients help reduce the impact of glucocorticoids on the bones. Other possible treatments include testosterone replacement therapy and osteoporosis medication. Alendronate and risedronate are two bisphosphonate medications approved by the U.S. Food and Drug Administration (FDA) for use by men and women with glucocorticoid-induced osteoporosis.