|
Bone
loss due to secondary osteoporosis is a result of taking medications or
having other medical conditions (Table 1). (1-2,
4-5) Interestingly, medications that treat psychiatric or neurologic disorders
may cause osteoporosis, and the diagnosis itself can have psychological
implications. (1) Secondary osteoporosis is more likely to occur in HIV-positive
people taking antiretrovirals. One-third to one-half of osteoporosis cases
in men are primarily the result of genetics. (2) Men and perimenopausal
women with osteoporosis more commonly have secondary causes for bone loss
than do postmenopausal women. Estrogen or testosterone deficiency during
adolescence leads to low peak bone mass but excess thyroid hormones may
be associated with substantial bone loss. (5) Bone turnover is increased
in these people but bone resorption is increased more than bone formation.
Among men, 30- 60% of osteoporosis is associated with secondary causes;
hypogonadism, glucocorticoids, and alcoholism are the most common. The
relationship between diabetes and osteoporosis is more controversial. Patients
with type 1 diabetes, especially those with poor blood sugar control (16),
are at greater risk of osteoporosis than patients with type 2 diabetes.
(17)
Diseases that reduce intestinal
absorption of calcium and phosphorus, or impair the availability of vitamin
D, can also cause bone disease. (5) Malabsorption, documented to
occur in some people with HIV, can result in osteoporosis and if it is
severe it may cause osteomalacia. Other diseases reported in people with
HIV that impair liver function, such as chronic active hepatitis and alcoholic
cirrhosis, may result in disturbed vitamin D metabolism and cause bone
loss by other mechanisms. Psychiatric disorders experienced by some HIV-positive
people can have a negative impact on bone health as well.
Diseases of bone can be
caused by bacterial infections, such as severe gum inflammation or periodontal
disease, which can cause bone loss around the teeth. (5) This can be a
concern particularly for HIV-positive people as they may be more susceptible
to bacterial infections and have other disorders that result in reduced
nutrient intake. Oral bone loss and tooth loss are also associated with
estrogen deficiency and osteoporosis. People with poor oral health habits
may benefit from oral examination and x-rays of the area to determine extra-oral
bone loss.
People with secondary
osteoporosis typically experience more bone loss than would be expected
for a normal individual of the same age, gender, and race. Both primary
and secondary osteoporosis can be lessened and prevented through adequate
nutrition, physical activity, and appropriate treatment if needed.
|
|
