When most people think of osteoporosis, they imagine age-related bone loss. But millions of people experience “secondary osteoporosis” — bone loss caused by another medical condition or long-term medication use. Unlike primary osteoporosis, this form often goes undetected because the underlying cause overshadows the symptoms.
In clinical practice, we see patients who are otherwise “healthy-looking” yet develop unexpected fractures or drastically low bone density. The reason? A silent secondary factor accelerating bone loss behind the scenes.
In this article, we break down common causes, red flags, diagnosis pathways, and personalised prevention strategies — especially helpful for GPs, rheumatologists, endocrinologists, and patients seeking clarity.
What Is Secondary Osteoporosis?
Secondary osteoporosis refers to bone weakening caused by an identifiable medical condition, hormone imbalance, or medication. These factors disrupt bone formation, increase bone resorption, or alter calcium and vitamin D metabolism.
Understanding the “why” behind bone loss helps clinicians tailor treatment and often reverse the underlying cause.
Common Secondary Causes of Osteoporosis
1. Rheumatoid Arthritis (RA)
RA is one of the strongest autoimmune predictors of bone loss.
How RA Causes Bone Loss
- Chronic inflammation increases TNF-α and IL-6 → accelerates bone resorption
- Reduced physical activity due to joint pain
- Frequent steroid use exacerbates bone loss
Who is at risk?
- RA patients diagnosed for >1 year
- Postmenopausal women with RA
- Anyone on long-term corticosteroids
2. Long-Term Corticosteroid Use (Steroid-Induced Osteoporosis)
Prednisolone and similar steroids significantly increase osteoporosis risk. you can learn more about steroid induced osteoporosis here.
Mechanisms
- Decrease bone formation
- Increase calcium loss
- Reduce sex hormones
- Weaken muscle → higher fall risk
High-Risk Groups
- 5 mg/day prednisolone for ≥3 months
- Asthma, COPD, RA, IBD, dermatology patients
3. Thyroid Disorders (Especially Over-Treatment)
Thyroid hormones directly influence bone turnover.
Hyperthyroidism
Excess thyroid hormones → rapid bone turnover → low BMD.
Over-treated Hypothyroidism
Even slight over-supplementation of levothyroxine can cause bone loss.
Red Flags
- TSH persistently low
- Palpitations + weight loss + bone pain
- Fragility fractures in patients on thyroid meds
4. Diabetes — Especially Type 1
Chronic hyperglycemia damages bone microarchitecture.
Why Diabetes Causes Bone Loss
- Reduced osteoblast activity
- Increased oxidative stress
- Higher fall and fracture risk
5. Malabsorption Disorders
Conditions that impair nutrient absorption directly affect bone metabolism.
Includes:
- Coeliac disease
- Crohn’s disease
- Chronic diarrhoea
- Gastric bypass surgery
Key Issue:
Low calcium, vitamin D, and magnesium → weaker bones.
6. Low Sex Hormone States
Estrogen and testosterone are vital for bone health.
Common causes:
- Early menopause
- One ovary removal
- PCOS with ovulatory dysfunction
- Testosterone deficiency in men
How Patients and GPs Can Identify Risk Early
1. Look for “Silent” Red Flags
- Unexplained back pain
- Height loss
- Fragility fractures
- Chronic steroid use
- Autoimmune disease history
- Thyroid medication dose adjustments
- Weight loss, fatigue, palpitations
2. Order the Right Baseline Assessments
GPs should consider screening when secondary osteoporosis is suspected:
Essential Tests
- DEXA Scan (Gold standard)
- Vitamin D levels
- Calcium + PTH
- Thyroid panel
- CRP/ESR (for inflammatory disorders)
- Sex hormones (E2/Testosterone)
- HbA1c
3. Specialised Secondary Causes Panel
At the London Osteoporosis Clinic, we perform a deeper evaluation including:
- Bone turnover markers
- Adrenal function
- Coeliac screening
- Medication review
- Fall risk assessment
This helps identify whether the bone loss is primary or secondary — a distinction crucial for targeted treatment.
Tailored Prevention and Treatment Strategies
1. Correct the Underlying Cause
- Optimise thyroid medication dosing
- Manage RA inflammation early
- Reduce steroid dose when clinically possible
- Treat coeliac or malabsorption conditions
- Balance sex hormones where indicated
2. Personalised Bone Strengthening Plan
A typical evidence-based plan includes:
✓ Optimal Vitamin D & Calcium
Individually calculated based on labs, not one-size-fits-all.
✓ Weight-Bearing Exercise Program
Walking, resistance training, strength balance exercises.
✓ Medications When Needed
Bisphosphonates, denosumab, or anabolic agents depending on severity.
✓ Fall Prevention Strategies
Why Secondary Osteoporosis Often Goes Undiagnosed
- Symptoms overlap with the primary disease
- Patients look healthy and active
- No fractures until late stage
- Medication side effects not discussed
- TSH or steroid dosing not regularly reviewed
Awareness is key. This type of osteoporosis is often preventable when detected early.
Takeaway
Secondary osteoporosis is common, silent, and often overlooked — but highly treatable when the root cause is identified. Whether the trigger is RA, thyroid disease, steroids, or malabsorption, the aim should be whole-person bone health management rather than treating bones in isolation.
Expert Help With Secondary Osteoporosis
At London Osteoporosis Clinic, our Bone Revive Programme is designed for patients with complex or secondary causes of bone loss. We focus on:
- Root-cause identification
- Expert rheumatology and endocrinology input
- Medical + lifestyle + nutrition optimisation
- Personalised treatment plans
If you suspect secondary osteoporosis — or are on long-term steroids or thyroid medication — getting evaluated early can protect your bones for decades.
