Common Cushing’s syndrome or corticosteroid therapy (e.g., >5 mg/day for >3 months) Excessive alcohol use† Primary or secondary hypogonadism (e.g., associated with medications, such as corticosteroids, opioids, and androgen-deprivation therapy for prostate cancer) Low calcium intake and vitamin D deficiency or insufficiency (serum 25-hydroxyvitamin D <30 ng/ml [75 nmol/liter]) Smoking Family history of minimal-trauma fracture
Less Common Low BMI (<20) and eating disorders associated with decreased BMI Lack of exercise or excessive exercise Antiepileptic drugs (phenytoin, phenobarbitone, primidone, carbamazepine) Thyrotoxicosis or thyroxine overreplacement Primary hyperparathyroidism Chronic liver or kidney disease Malabsorption, including celiac disease Hypercalciuria Rheumatoid arthritis or ankylosing spondylitis Type 1 or type 2 diabetes mellitus Multiple myeloma or other monoclonal gammopathies HIV or its treatment with protease inhibitors Mastocytosis Organ transplantation or immunosuppressive agents (cyclosporine and tacrolimus) Osteogenesis imperfecta