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Understanding the Difference Between Primary and Secondary Osteoporosis

Primary Vs. Secondary – The Types of Osteoporosis

Types of Osteoporosis | Primary Osteoporosis | Causes of Secondary Osteoporosis | Primary and Secondary Osteoporosis treatment Options

There are four types of osteoporosis: primary osteoporosis, secondary osteoporosis, osteogenesis imperfecta, and idiopathic juvenile osteoporosis.

From there, the two main types of osteoporosis common in adults are: primary and secondary osteoporosis.

  • Primary osteoporosis is known as either being age-related osteoporosis, or an unknown cause.(1) This is the most common form of osteoporosis. Why? The biggest factor is age. As you know, once you reach peak bone mass you begin to lose 1% of your total bone density, annually. This is coupled with the fact that as you also get older, your ability to build bone also decreases. Bone loss increases, bone building decreases. A dangerous cocktail. There are two types of primary osteoporosis: type 1 and type 2.

Type 1: Also known as postmenopausal osteoporosis. This generally develops in women after menopause due to decreases in estrogen production. But can also be from testosterone deficiency. This type is more common in women than men and typically during the ages of 50-70 years old.

Type 2: Also known as senile osteoporosis. This typically develops after the age of 70 in older men and women, although it’s more common in women. It is associated with decreased bone formation and a decrease in vitamin D production.

  • Secondary osteoporosis on the other hand is when the loss of bone is caused by certain lifestyle behaviors, diseases or medications. Unfortunately, there is a long list of medical conditions or diseases that lead to low bone mass. They range from genetic conditions such as diabetes, cystic fibrosis to blood disorders such as anemia. If you have a chronic condition and have been taking medication for some time, it’s even more crucial to focus on diet and exercise. You may be surprised to learn that some of the most common medications contribute to bone loss. These include contraceptives, aromatase inhibitors, anticonvulsants, thyroid medications and blood coagulants to name a few. For the complete list, click here.

Primary Osteoporosis

  • Osteogenesis imperfecta is an extremely rare form of osteoporosis and is present at birth. With osteogenesis imperfecta, bones break easily and without reason and is caused by several genes that don’t function properly.
  • Idiopathic juvenile osteoporosis is usually seen as a secondary feature from either a chronic disease or from treatment (medications for a chronic condition). For a full list of diseases that can lead to osteoporosis in children, go here.

Is There Really Such a Thing as Primary Osteoporosis?

We’ve defined the technical term for primary osteoporosis above. But is this term still relevant? Is there really such a thing as ‘primary’ osteoporosis?

Let me explain…

Authorities and experts state that there is no direct or singular cause for primary osteoporosis.(2) Yes, primary osteoporosis is vaguely attributed to age-related bone loss, but we now know that it’s caused by concrete factors that affect the aging population.

These include:

  • Vitamin D Deficiency: Recent research shows a high prevalence of vitamin D deficiency afflicting over half of certain elderly populations! This is also associated with a higher risk of fracture. (3)
  • Reduced Muscle Mass: Older adults tend to lose lean tissue more rapidly than their younger counterparts during prolonged periods of physical inactivity.(4) As with decreased bone density as you age, this also happens with muscle mass.
  • Lack of bone supporting nutrients: Poor nutrition or malnutrition occurs in 15 to 20% of the elderly population.(5) Making sure you are getting adequate amounts of the vitamins and minerals needed for bone health is crucial.

Starting to make sense?

You see, it’s important to uncover the underlying cause of your osteoporosis.

Take Lara Pizzorno, author of “Your Bones” for instance. She discovered she had osteopenia in her early 40s! Instead of accepting that it may be due to certain risk factors such as family history, gender and race… she decided to look for any additional underlying causes to explain her bone loss.

And she did. She found out that she has a vitamin D receptor that doesn’t function properly, making it difficult for her to absorb vitamin D. She also found out that she doesn’t activate certain B vitamins. So while these inabilities contribute to bone loss, she is now informed. With this knowledge, Lara was able to treat the cause, instead of suppressing her symptoms. Watch her full story.

So if you are suffering from bone loss, we recommend looking deeper. You may be surprised at what you find.

Causes Associated with Secondary Osteoporosis

As we discussed, secondary osteoporosis is caused by certain lifestyle factors, diseases or nutritional deficiencies.

The following tables provide insight into secondary causes:


Nutrition Anti-Nutrients Common Diet Choices/Habits
Food restriction Cola type sodas High sugar intake
Lack of bone building nutrients Excess salt intake Processed and refined foods
Imbalance of bone building nutrients Excess alcohol consumption High starch intake
Excess Phosphorous Excess caffeine intake Inadequate intake of fruits and vegetables
Excess vitamin A Skipping meals

Lifestyle Factors:

Physical Activity Other
Inadequate physical activity Smoking
Muscle deterioration Stress (increases levels of cortisol)
Immobilization (bed rest) Mood (fear, unhappiness or worry)
Surgeries (bariatric, hysterectomy, gastrointestinal etc.)
Use of sunscreen

Medical Conditions:

Digestive Disorders Rheumatological / Autoimmune Diseases Connective tissue / Genetic disorders Endocrine or Metabolic Causes Neurological Diseases
Celiac Disease Rheumatoid Arthritis Cystic fibrosis Hyperparathyroidism Spinal cord injury
Gastric Bypass Multiple Sclerosis Glycogen storage diseases Hyperthyroidism Parkinson’s disease
Inflammatory Bowel Disease Lupus Hypophosphatasia Adrenal disorders, including:

Adrenal insufficiency

Cushing’s syndrome




The following are the medicine classes which are currently known to play a role in or cause bone loss:

Drug Class Commonly Prescribed For –

  • NSAIDS – Non-steroidal Anti-inflammatory Drugs pain relief, especially arthritic pain
  • Corticosteroids – a wide variety of conditions
  • Contraceptives – the pill, plus injectable
  • Aromatase Inhibitors – cancer treatment
  • Gonadotrophin releasing agonists – endometriosis, breast cancer, prostate
  • Anticonvulsants – epilepsy, bipolar, neuropathic pain
  • Benzodiazepines – depression, schizophrenia, insomnia
  • Antidepressants – depression, anxiety
  • Insulin sensitizing agents – type 2 diabetes
  • Opioid Pain Medications – severe pain management
  • Calcineurin inhibitors – immune system suppression
  • Antacids/Proton Pump Inhibitors – indigestion, heart burn
  • Loop diuretics – blood pressure, liver cirrhosis
  • Blood coagulants – prevent excessive blood clotting
  • Thyroid Medications – hypothyroidism

Please consult your doctor before stopping or altering the dosage of any medication. Only your doctor and you can decide the risks versus benefits of a medicine.

Primary & Secondary Osteoporosis Treatment

Osteoporosis treatments include a multifaceted approach focusing on diet, lifestyle habits, exercise and for some, medications. AlgaeCal Plus

But the good news is, there are natural treatment options if this is what you choose.

One in particular, has been backed by science and published in prominent and peer-reviewed journals such as PubMed, The Nutrition Journal and now a 7-year follow up study in the Journal of the American College of Nutrition. It’s the only bone-building supplement to be backed by this type of research.

It’s called AlgaeCal. And it’s been supported to increase bone density…even in 80 year old women! Naturally. And without side effects. For more information on this multi-mineral bone supplement, go here.

  3. Thomas MK et al, Hypovitaminosis D in medical inpatients. N Eng J Med 1998;338:777-783
  4. English, Kirk L., and Douglas Paddon-Jones. “Protecting Muscle Mass and Function in Older Adults during Bed Rest.” Current Opinion in Clinical Nutrition and Metabolic Care 13.1 (2010): 34–39. PMC. Web. 25 Feb. 2016.

Author: Monica Straith, BS

Monica is the PR and Outreach Manager and Fitness Lead at AlgaeCal. She’s an ACE Certified Personal Trainer and Nutrition Specialist, and has a B.S. and B.A. from the University of Wisconsin-Madison, where she played varsity soccer for four years. Monica pulls from her experience in athletics and health to contribute to AlgaeCal and has also been featured on myfitnesspal blog, Prevention, and Huffington Post.