Sobh Mahmoud M, Abdalbary Mohamed, Elnagar Sherouk, Nagy Eman, Elshabrawy Nehal, Abdelsalam Mostafa, Asadipooya Kamyar, El-Husseini Amr
Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura 35516, Egypt.
Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY 40506, USA.
J Clin Med. 2022 Apr 24;11(9):2382. doi: 10.3390/jcm11092382.
Fragility fracture is a worldwide problem and a main cause of disability and impaired quality of life. It is primarily caused by osteoporosis, characterized by impaired bone quantity and or quality. Proper diagnosis of osteoporosis is essential for prevention of fragility fractures. Osteoporosis can be primary in postmenopausal women because of estrogen deficiency. Secondary forms of osteoporosis are not uncommon in both men and women. Most systemic illnesses and organ dysfunction can lead to osteoporosis. The kidney plays a crucial role in maintaining physiological bone homeostasis by controlling minerals, electrolytes, acid-base, vitamin D and parathyroid function. Chronic kidney disease with its uremic milieu disturbs this balance, leading to renal osteodystrophy. Diabetes mellitus represents the most common secondary cause of osteoporosis. Thyroid and parathyroid disorders can dysregulate the osteoblast/osteoclast functions. Gastrointestinal disorders, malnutrition and malabsorption can result in mineral and vitamin D deficiencies and bone loss. Patients with chronic liver disease have a higher risk of fracture due to hepatic osteodystrophy. Proinflammatory cytokines in infectious, autoimmune, and hematological disorders can stimulate osteoclastogenesis, leading to osteoporosis. Moreover, drug-induced osteoporosis is not uncommon. In this review, we focus on causes, pathogenesis, and management of secondary osteoporosis.
脆性骨折是一个全球性问题，是导致残疾和生活质量受损的主要原因。它主要由骨质疏松症引起，其特征是骨量和/或骨质量受损。正确诊断骨质疏松症对于预防脆性骨折至关重要。由于雌激素缺乏，骨质疏松症在绝经后女性中可能是原发性的。继发性骨质疏松症在男性和女性中都并不罕见。大多数全身性疾病和器官功能障碍都可导致骨质疏松症。肾脏通过控制矿物质、电解质、酸碱平衡、维生素D和甲状旁腺功能，在维持生理骨稳态中发挥关键作用。慢性肾脏病及其尿毒症环境会扰乱这种平衡，导致肾性骨营养不良。糖尿病是骨质疏松症最常见的继发性病因。甲状腺和甲状旁腺疾病可使成骨细胞/破骨细胞功能失调。胃肠道疾病、营养不良和吸收不良可导致矿物质和维生素D缺乏及骨质流失。慢性肝病患者因肝性骨营养不良而发生骨折的风险更高。感染性、自身免疫性和血液学疾病中的促炎细胞因子可刺激破骨细胞生成，导致骨质疏松症。此外，药物性骨质疏松症也并不罕见。在本综述中，我们重点关注继发性骨质疏松症的病因、发病机制和管理。
