Endocrine-related osteoporosis: bone quality, clinical phenotype, and targeted management

Area of Science:

• Endocrinology
• Bone Biology
• Osteoporosis Research

Background:

• Secondary osteoporosis is an under-recognized cause of skeletal fragility, especially in specific patient groups.
• Endocrine disorders significantly impact bone remodeling, mineral metabolism, and hormonal regulation, contributing to bone loss.
• Current diagnostic tools like bone mineral density (BMD) and FRAX may be insufficient for assessing fracture risk in these patients.

Purpose of the Study:

• To synthesize current knowledge on endocrine-related secondary osteoporosis.
• To highlight diagnostic red flags and targeted management strategies for endocrine-related bone fragility.
• To propose a novel clinical framework for improved fracture risk stratification and treatment decisions.

Main Methods:

• Review of clinical guidelines and relevant literature on endocrine disorders and osteoporosis.
• Focus on disease-specific skeletal phenotypes and limitations of conventional assessment tools.
• Development of a practical framework integrating endocrine assessment, imaging, and biochemical markers.

Main Results:

• Endocrine disorders are key drivers of secondary osteoporosis, affecting multiple bone pathways.
• Bone quality is a critical determinant of fracture risk, often underestimated by BMD alone.
• The proposed framework enhances identification of high-risk individuals beyond traditional densitometric models.

Conclusions:

• A mechanism-based approach, integrating endocrine factors and bone quality, is crucial for managing secondary osteoporosis.
• The proposed clinical framework facilitates more accurate fracture risk assessment and personalized therapeutic strategies.
• This approach supports a shift towards optimizing the use of anabolic and antiresorptive therapies in high-risk patients.