Osteoporosis Causes Part I: What Low T-Scores Might Mean

Are you taking an osteoporosis medication and seeing very little improvement? If so, this is very frustrating because we do all we're suppose to and then when we have our next DXA, and the numbers are the same, worse, or show a tiny improvement because we may have a secondary cause for this that needs to be treated. We get a lot of questions from members who don't see any bone mineral density (BMD) improvements with their osteoporosis medications, so I thought we should go over some things that could help to explain this.

According to some studies, 20 to 30 % of women have a secondary cause of osteoporosis and 50 % of men do as well. Once secondary causes are identified and treated, bone loss can be reversed.

Let's start by explaining the normal risk factors:

  • A thin, small-boned frame

  • Previous fracture or family history of osteoporotic fracture

  • Estrogen deficiency, resulting from early menopause (before age 45), either naturally, from surgical removal of the ovaries, or as a result of prolonged amenorrhea (abnormal absence of menstruation) in younger women

  • Advanced age

  • A diet low in calcium

  • Caucasian or Asian ancestry (African Americans and Hispanics are at lower but significant risk)

  • Cigarette smoking

  • Excessive use of alcohol

  • Prolonged use of certain medications. Source: (NAIMS 2009)

There are two forms of osteoporosis, primary - from age-related bone loss - and secondary. There are many secondary causes that would have to be treated differently from primary osteoporosis. If you have been taking osteoporosis medications and haven't seen any improvements maybe you have a secondary cause for this.

List of secondary causes for osteoporosis:


  • Hyperparathyroidism

  • Ankylosing spondylitis

  • Hyperthyroidism

  • Blood and bone marrow disorders

  • Idiopathic scoliosis

  • Breast cancer

  • Inflammatory bowel

  • Cushing's syndrome

  • Diabetes mellitus

  • Eating disorders

  • Kidney disease

  • Emphysema

  • Lupus

  • Female athlete triad

  • Multiple sclerosis

  • Gastrectomy

  • Celiac and Crohns

  • Gastrointestinal bypass procedures

  • Mineral metabolism problems

  • Lymphoma and leukemia

  • Organ transplant

If you haven't been checked for any of these, or you suspect you may have one or more, talk with your doctor about testing for those you feel might be the culprit. This is not a full list of secondary disorders; to see a full list go to the National Osteoporosis Foundation's page on secondary disorders.

Good luck finding out if you have a secondary cause for osteoporosis and treating it successfully. Once you've accomplished this, you should see improvements in your next DXA scan.

Next week we'll discuss medications that can cause osteoporosis and how to identify and treat them so you'll see the BMD increases you should from your hard work treating this disorder.

Pam Flores
Meet Our Writer
Pam Flores

Pam wrote for HealthCentral as a patient expert for Osteoporosis.