Endocrine and metabolic risk factors for fragility fracture (diabetes, hyponatraemia, thyroid, aldosteronism)
Core concept
- Fracture risk = bone quantity (BMD) + bone quality + falls risk. Endocrine causes hit all three, and several do it without lowering the T-score
- Established endocrine/metabolic causes
- Glucocorticoid excess - exogenous or Cushing's; the commonest secondary cause
- Hyperthyroidism / over-replacement with thyroxine - inc bone turnover
- Hypogonadism - early menopause, POI, androgen deprivation, anorexia/RED-S, hyperprolactinaemia
- Primary hyperparathyroidism - cortical bone loss (distal radius) more than spine
- Vitamin D deficiency and osteomalacia
- Type 1 diabetes - low BMD AND poor quality -> hip fracture RR ~6
- Primary aldosteronism - hypercalciuria and secondary hyperparathyroidism
- Chronic hyponatraemia - independently associated with falls, osteoporosis and fracture
- Acromegaly (vertebral fractures with normal BMD), CKD-MBD
3 more sections, plus exam facts
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