Osteoporosis is a worldwide public health issue, with fractures causing major morbidity and mortality. However, postmenopausal osteoporosis was the most prevalent; secondary osteoporosis affected up to 30% of postmenopausal women, less than 50% of premenopausal women, and 50% to 80% of males. The exclusion of secondary causes was critical since therapy for such people frequently began with addressing the underlying illness. These range from endocrine to chronic inflammatory and hereditary diseases and are often overlooked. General screening is advised for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and males over 50, older patients with no classical risk factors for osteoporosis, and all patients with the lowest bone mass. Secondary osteoporosis may respond insufficiently to traditional anti-osteoporosis medication if the underlying illness is undiagnosed and untreated. 

In some chronic illnesses, such as glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, bone densitometry utilizing dual-energy x-ray absorptiometry may underestimate fracture risk. In contrast, in others, it may overstate fracture risk (e.g., Turner syndrome). FRAX and trabecular bone score may give extra information on fracture risk in secondary osteoporosis, although they are only useful in individuals over 40 and 50, respectively. 

Furthermore, FRAX must be adjusted for chronic illnesses, such as glucocorticoid usage, type 2 diabetes, and HIV. In most cases, the only evidence for antiresorptive or anabolic treatment is increased bone mass.

Reference:academic.oup.com/edrv/article/43/2/240/6363556