Secondary osteoporosis is a metabolic bone disease that causes bone loss, bone microstructure destruction, increased bone fragility, and easy fractures due to diseases or drugs. There are many causes of secondary osteoporosis. Clinically, endocrine and metabolic diseases, connective tissue diseases, kidney diseases, digestive tract diseases and drugs are more common.
Introduction to secondary osteoporosis
Secondary osteoporosis
Secondary osteoporosis
Secondary osteoporosis is a metabolic bone disease caused by bone loss, bone microstructure destruction, increased bone fragility, and easy fractures due to diseases or drugs. The incidence is about 60%, and women are far more than men. Therefore, it is necessary to actively prevent the occurrence of osteoporosis, especially for the elderly who are at risk for fractures.
Common causes of secondary osteoporosis
1. Endocrine and metabolic diseases
Hyperparathyroidism, Cushing Syndrome, Hypogonadism, Hyperthyroidism, Pituitary Prolactinoma, Diabetes (mainly seen in type 1 diabetes), Hypothyroidism, etc.
1. Symptoms vary depending on the degree of osteoporosis and the nature of the primary disease.
Most symptoms are concealed, non-diagnostic specific, and often obscured by the manifestation of the primary disease. Many patients found that they had complicated osteoporosis when they performed X-ray examination. Some patients complain of back pain, fatigue, limb twitching, or difficulty moving. In severe cases, there can be obvious bone pain, and minor injuries are prone to fractures of the spine, ribs, hips or long bones. Rib fractures are more common in secondary osteoporosis than in primary osteoporosis.
Thin people are more susceptible to osteoporosis
2. The main signs are similar to those of primary osteoporosis, but may have shortened height. In severe cases, kyphosis, kyphosis or thorax deformity may occur.
3. Various clinical manifestations of primary disease.
Diagnosis of secondary osteoporosis
Diagnostic indicators of secondary osteoporosis
At present, there is no clinical method for directly measuring bone strength, so the following diagnostic indicators are often used clinically: low bone density and / or fragile fractures. For secondary osteoporosis, it is necessary to have a clear cause of osteoporosis.
1. Fragile fracture: It is the ultimate consequence of the decrease in bone strength. Therefore, a secondary osteoporosis can be diagnosed if there is a fragile fracture caused by a specific disease or drug.
Diabetic osteoporosis
2.Determination of bone mineral salt density
3. Bone mineral density measurement method: Z value should be paid more attention when analyzing the results.
Diagnostic criteria for secondary osteoporosis
Follow the diagnostic criteria recommended by the World Health Organization (WHO). See the guidelines for the diagnosis and treatment of primary osteoporosis.
X-ray plain film: It has low sensitivity and accuracy for the diagnosis of osteoporosis, so it does not help the early diagnosis of osteoporosis. However, it is of great value to detect the presence or absence of fractures and distinguish them from fracture tumors and joint lesions.
Determination of bone turnover biochemical indicators: At present, there is no biochemical indicator that can be used as a diagnostic indicator of osteoporosis. It is mainly used for typing of bone turnover, judging the rate of bone loss, monitoring the condition, and evaluating the efficacy of drugs. The commonly used biochemical indicators of bone turnover can be found in the guidelines for the diagnosis and treatment of primary osteoporosis.
The primary disease-related examinations that cause osteoporosis: such as liver and kidney function, autoimmune indicators, thyroid function, parathyroid function, gonadal function, and tumor-related tests.
Treatment options for secondary osteoporosis
1. Treatment of primary diseases: Actively looking for the cause of osteoporosis is of great significance for the effective treatment of secondary osteoporosis. Once the cause is clear, the primary disease should be treated in time.
2. General measures: Pay attention to eating a balanced diet rich in calcium, low salt and moderate protein. Under the premise of not affecting the treatment of the primary disease, appropriate outdoor activities to increase sunlight exposure, increase the coordination of the body, prevent wrestling, avoid alcohol and tobacco addiction, and use other drugs that may affect bone health with caution.
3, basic drug treatment: including appropriate calcium supplements, vitamin D or its active metabolites. Refer to the guidelines for the diagnosis and treatment of primary osteoporosis. It is important to note that if patients have hypercalcemia, such as tumors or hyperparathyroidism, the use of calcium and vitamin D preparations should be contraindicated. If patients are accompanied by kidney stones and high urinary calcium output, calcium and vitamin D preparations should be used with caution.
4. Drug treatment: If necessary, treat with effective bone resorption inhibitors (such as bisphosphonates and calcitonin). For medication usage and precautions, see the guidelines for diagnosis and treatment of primary osteoporosis. Whether bone formation promoters (such as parathyroid hormone amino acid end fragments) are suitable for secondary new osteoporosis remains to be accumulated in the future.
Special treatment for secondary osteoporosis
Sex hormone deficient osteoporosis: Active treatment of primary disease. Young female patients should be supplemented with appropriate amounts of estrogen, estrogen and progestin, and male patients should be supplemented with androgens. If necessary, use other anti-osteoporosis drugs.
2. Glucocorticoid-induced osteoporosis: physiological doses of glucocorticoids can also cause bone loss, the most significant decrease in bone mass 6 to 12 months after administration. Certain diseases require long-term application of glucocorticoids. If the condition permits, the lowest dose should be used. Supplementation of calcium, vitamin D preparations, and bisphosphonate anti-osteoporosis drugs as appropriate can help prevent glucocorticoid osteoporosis. For patients with obvious bone pain, calcitonin drugs can be added.
3. Braking (disuse) osteoporosis: general treatment and drug treatment are the same as primary osteoporosis, but special attention should be paid to functional exercise and rehabilitation of the braking site.
4. Osteoporosis caused by long-term parenteral nutrition support: General treatment and drug treatment are the same as primary osteoporosis. As the disease is prone to rickets (or osteomalacia), in addition to using aluminum-free nutritional support solution, vitamin D preparations must be actively supplemented.
5. Diabetic osteoporosis: It is mainly to strictly control hyperglycemia, and at the same time apply anti-osteoporosis drugs.
6. Osteoporosis after organ transplantation: same as primary osteoporosis
7, hemodialysis osteoporosis: prevention and treatment methods are the same as primary osteoporosis. Avoid using aluminum-containing dialysate and low-phosphorus dialysate.
Secondary osteoporosis