Abstract #999572: A Case of Secondary Osteoporosis with Latent Hypogonadotropic Hypogonadism: Ongoing Undertreatment of Fragility Fractures

2021 ◽  
Vol 27 (6) ◽  
pp. S189-S190
Author(s):  
Michael Ahlers ◽  
Azadeh Lankarani-Fard
Keyword(s):  
Hypogonadotropic Hypogonadism ◽  
Fragility Fractures ◽  
Secondary Osteoporosis

scholarly journals Management of primary and secondary osteoporosis in children

2020 ◽  
Vol 12 ◽  
pp. 1759720X2096926
Author(s):  
Sophia D. Sakka ◽  
Moira S. Cheung
Keyword(s):  
Bone Fractures ◽  
Bone Biopsy ◽  
Treatment Options ◽  
Quantitative Computed Tomography ◽  
Fragility Fractures ◽  
Secondary Osteoporosis ◽  
Long Bone ◽  
Vertebral Fracture Assessment ◽  
Primary Osteoporosis ◽  
Mineral Density

Osteoporosis in children differs from adults in terms of definition, diagnosis, monitoring and treatment options. Primary osteoporosis comprises primarily of osteogenesis imperfecta (OI), but there are significant other causes of bone fragility in children that require treatment. Secondary osteoporosis can be a result of muscle disuse, iatrogenic causes, such as steroids, chronic inflammation, delayed or arrested puberty and thalassaemia major. Investigations involve bone biochemistry, dual-energy X-ray absorptiometry scan for bone densitometry and vertebral fracture assessment, radiographic assessment of the spine and, in some cases, quantitative computed tomography (QCT) or peripheral QCT. It is important that bone mineral density (BMD) results are adjusted based on age, gender and height, in order to reflect size corrections in children. Genetics are being used increasingly for the diagnosis and classification of various cases of primary osteoporosis. Bone turnover markers are used less frequently in children, but can be helpful in monitoring treatment and transiliac bone biopsy can assist in the diagnosis of atypical cases of osteoporosis. The management of children with osteoporosis requires a multidisciplinary team of health professionals with expertise in paediatric bone disease. The prevention and treatment of fragility fractures and improvement of the quality of life of patients are important aims of a specialised service. The drugs used most commonly in children are bisphosphonates, that, with timely treatment, can give good results in improving BMD and reshaping vertebral fractures. The data regarding their effect on reducing long bone fractures are equivocal. Denosumab is being used increasingly for various conditions with mixed results. There are more drugs trialled in adults, but these are not yet licenced for children. Increasing awareness of risk factors for paediatric osteoporosis, screening and referral to a specialist team for appropriate management can lead to early detection and treatment of asymptomatic fractures and prevention of further bone damage.

scholarly journals Endocrine Causes of Secondary Osteoporosis in Adults: Mechanisms and Evaluation

2021 ◽  
Author(s):  
Himanshu Sharma ◽  
Anshul Kumar ◽  
Balram Sharma ◽  
Naincy Purwar ◽  
Sandeep K Mathur ◽  
...  
Keyword(s):  
Preventive Intervention ◽  
Treatment Options ◽  
Premenopausal Women ◽  
Fragility Fractures ◽  
Underlying Disease ◽  
Secondary Osteoporosis ◽  
Public Health Issue ◽  
Mineral Density ◽  
Younger Men ◽  
Primary Disorder

Osteoporosis and fragility fractures are a major public health issue. Secondary osteoporosis is characterised by the presence of an underlying disease, deficiency, or use of a drug. Conditions that increase speculation for secondary osteoporosis include fragility fractures amongst the younger men or premenopausal women, markedly decreased Bone Mineral Density (BMD) values, and fractures despite conforming to anti-osteoporotic therapy. Since the emphasis is on the treatment of the primary disorder, a diagnosis of osteoporosis and thus the opportunity of preventive intervention can be missed. With this review, the authors objective is to emphasise the importance of secondary osteoporosis, discuss the causes and their mechanism and summarise treatment options.

scholarly journals Approach to the patient with secondary osteoporosis

2010 ◽  
Vol 162 (6) ◽  
pp. 1009-1020 ◽  
Author(s):  
Lorenz C Hofbauer ◽  
Christine Hamann ◽  
Peter R Ebeling
Keyword(s):  
Premenopausal Women ◽  
Fragility Fractures ◽  
Underlying Disease ◽  
Vitamin D Supplementation ◽  
Secondary Osteoporosis ◽  
X Rays ◽  
Mineral Density ◽  
Hydroxyvitamin D ◽  
Younger Men ◽  
25 Hydroxyvitamin D

AbstractSecondary osteoporosis is characterized by low bone mass with microarchitectural alterations in bone leading to fragility fractures in the presence of an underlying disease or medication. Scenarios that are highly suspicious for secondary osteoporosis include fragility fractures in younger men or premenopausal women, very low bone mineral density (BMD) values, and fractures despite anti-osteoporotic therapy. An open-minded approach with a detailed history and physical examination combined with first-line laboratory tests are aimed at identifying clinical risk factors for fractures, osteoporosis-inducing drugs, and underlying endocrine, gastrointestinal, hematologic, or rheumatic diseases, which then need to be confirmed by specific and/or more invasive tests. BMD should be assessed with bone densitometry at the hip and spine. Lateral X-rays of the thoracic and lumbar spine should be performed to identify or exclude prevalent vertebral fractures which may be clinically silent. Management of secondary osteoporosis includes treatment of the underlying disease, modification of medications known to affect the skeleton, and specific anti-osteoporotic therapy. Calcium and vitamin D supplementation should be initiated with doses that result in normocalcemia and serum 25-hydroxyvitamin D concentrations of at least 30 ng/ml. Oral and i.v. bisphosphonates are effective and safe drugs for most forms of secondary osteoporosis. Severe osteoporosis may require the use of teriparatide.

Systematic approaches to fragility fracture prevention

2014 ◽  
Vol 23 (01) ◽  
pp. 39-44
Author(s):  
D. B. Lee ◽  
P. J. Mitchell
Keyword(s):  
Fragility Fracture ◽  
National Policy ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
The United States ◽  
Fracture Liaison Service ◽  
Reimbursement Mechanisms ◽  
Future Fracture ◽  
National Coalition ◽  
Fracture Liaison

SummaryIndividuals who have suffered fractures caused by osteoporosis – also known as fragility fractures – are the most readily identifiable group at high risk of suffering future fractures. Globally, the majority of these individuals do not receive the secondary preventive care that they need. The Fracture Liaison Service model (FLS) has been developed to ensure that fragility fracture patients are reliably identified, investigated for future fracture and falls risk, and initiated on treatment in accordance with national clinical guidelines. FLS have been successfully established in Asia, Europe, Latin America, North America and Oceania, and their widespread implementation is endorsed by leading national and international osteoporosis organisations. Multi-sector coalitions have expedited inclusion of FLS into national policy and reimbursement mechanisms. The largest national coalition, the National Bone Health Alliance (NBHA) in the United States, provides an exemplar of achieving participation and consensus across sectors. Initiatives developed by NBHA could serve to inform activities of new and emerging coalitions in other countries.

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