Saturday, April 25, 2009

Reader Question: What Are Other Causes of Osteoporotic Fractures?

Question: I keep seeing that one cause of osteoporotic fractures is certain bone disorders. I have looked around and couldnt find any specific names of disorders.

Answer: Almost all vertebral compression fractures are due to either osteoporosis, trauma or tumors (metastasis or primary bone tumors like multiple myeloma). There, a combination of the above. However, almost anything else that weakens the bone can cause a VCF.

Certain medical conditions make osteoporosis worse. The result is that patients with these disorders, also known as secondary osteoporosis, started getting fractures earlier. The two most common causes of secondary osteoporosis that I see are 1) chronic steroid use and 2) vitamin D deficiency (osteomalacia).

Chronic medical steroid use is relatively common in usually seen in patients with painful arthritis, such as rheumatoid arthritis. It is also commonly used on chronic basis in patients with lung disorders such as pulmonary fibrosis and chronic obstructive pulmonary disease (COPD).

In addition to these causes, most patients that I see with VCF also have osteomalacia (vitamin D deficiency). Abnormalities in thyroid, parathyroid or androgen (testosterone/estrogen) hormones are also very common secondary causes.

The most common medication that causes osteoporosis is steroids, probably followed by seizure medications (dilantin, etc). There several nutritional factors that can alter calcium metabolism and cause or worsen osteoporosis. These include frequent or excessive soda intake (alters the bodies normal acid-base balance), impaired calcium absorbtion (crohn's disease, sprue) or decreased calcium or vitamin D intake (lactose intolerate, etc).

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