Uncommon Conditions that Contribute Little to Osteoporosis

Acromegaly

Hyperparathyroidism

Osteogenesis imperfecta

Cushing's disease

Hypopituitarism

Multiple myeloma

Important Risk Factors

Cigarette smoking

Gonadal hypofunction

Leanness

Dilantin therapy

Hemiplegia

Obstructive lung disease

Ethanol consumption

Hyperthyroidism

Phenobarbital therapy

Gastrectomy

Inactivity

Thyroidectomy

Common Conditions with No Increased Risk for Osteoporosis

Diabetes mellitus

Parkinsonism

Peripheral vascular disease

Diverticulitis

Peptic ulcer disease

Stroke (without paralysis)

Inguinal hernia

(without gastrectomy)

Thyroid adenoma

Osteoarthritis

Rheumatoid arthritis (without disability)

Urolithiasis

FIGURE 6-3 Relative impact in the community of various purported causes of ''secondary" osteoporosis. Source: L. J. Melton III and B. L. Riggs, "Clinical Spectrum," Chapter 6 in B. L. Riggs and L. J. Melton III, eds., Osteoporosis: Etiology, Diagnosis, and Management , Raven Press, New York, 1988, pp. 155-179.

of women and 40 percent of men with vertebral or hip fractures.28 The greater proportion of men affected by secondary osteoporosis is due to their lower background level of the condition—men start with greater bone mass, lose bone less rapidly over life, and do not live as long as women. Consequently, men with fractures are more likely to have a specific cause of excessive bone loss; thus, identification and management of secondary osteoporosis should be a primary consideration for them.

The actual importance, however, of many of the putative causes of "secondary" osteoporosis (along with a host of other conditions not listed here) is uncertain. For example, population-based studies have shown that non-insulin-dependent diabetes mellitus was not associated with any increased risk of fracture or bone loss (in contrast to results of less rigorous clinical studies); recent work raises similar questions about the impact of asymptomatic hyperparathyroidism,28 which is the form increasingly being diagnosed. Other conditions, like rheumatoid arthritis and stroke, are only indirectly linked to bone loss and fractures as a result of disease-induced disability and consequent disuse osteoporosis.28 An important research priority, therefore, is to assess the practical impact of the myriad conditions associated with secondary osteoporosis to identify those with a significant influence on fracture risk in the population.

Smoking is also associated with reduced bone mass, as well as with hip and vertebral fractures, and is correlated with another risk



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