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Page: Etiology
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Family history of fracture or low bone mass are probably the most important etiological factors of primary osteoporosis. The heritability of the fracture as well as low BMD are relatively high, ranging from 25 to 80 percent. Estrogen deficiency following menopause is correlated with a rapid reduction in BMD. This, plus the increased risk of falling associated with aging, leads to fractures of the wrist, spine and hip. Other hormone deficiency states can lead to osteoporosis, such as testosterone deficiency. Glucocorticoid or thyroxine excess states also lead to osteoporosis. Lastly, calcium and/or vitamin D deficiency from malnutrition increases the risk of osteoporosis.
Other significant factors leading to the onset of osteoporosis include smoking cigarettes, low levels of physical activity (weight bearing exercise), and family history. Osteoporosis can be thought of as analogous to sarcopenia, which is the age-related loss of skeletal muscle. The combination of sarcopenia and osteoporosis results in the significant frailty often seen in the elderly population.
List of disorders associated with osteoporosis:
* Hypogonadal states - Turner syndrome, Klinefelter syndrome, Kallmann syndrome, anorexia nervosa, hypothalamic amenorrhea, hyperprolactinemia
* Other endocrine disorders - Cushing's syndrome, hyperparathyroidism, thyrotoxicosis, insulin-dependent diabetes mellitus, acromegaly, adrenal insufficiency
* Nutritional and gastrointestinal disorders - malnutrition, parenteral nutrition, malabsorption syndromes (e.g. coeliac disease, Crohn's disease), gastrectomy, severe liver disease (especially primary biliary cirrhosis)
* Rheumatologic disorders - rheumatoid arthritis, ankylosing spondylitis
* Hematologic disorders/malignancy - multiple myeloma, lymphoma and leukemia, mastocytosis, hemophilia, thalassemia.
* Inherited disorders - osteogenesis imperfecta, Marfan syndrome, hemochromatosis, hypophosphatasia, glycogen storage diseases, homocystinuria, Ehlers-Danlos syndrome, porphyria, Menkes' syndrome, epidermolysis bullosa.
* Medication:
o Steroid-induced osteoporosis (SIOP) due to use of glucocorticoids - analogous to Cushing's syndrome and involving mainly the axial skeleton
o Barbiturates (due to accelerated metabolism of vitamin D) and some other antiepileptics
* Other disorders - immobilization, scoliosis
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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