Various causes of secondary osteoporosis: coeliac disease,  hyperthyroidism, hypogonadism, IBD, chronic liver disease, JIA, chronic renal, immobility.

Consider calculating fracture risk if secondary osteoporosis or previous fragility fracture, frequent use of systemic steroids, FH hip fracture, low BMI, smoking/alcohol etc.

Use online tools FRAX or QFracture to estimate 10yr predicted fracture risk (FRAX includes previous bone mineral density value if DXA done, not necessary).  If risk is in the region of “intervention threshold” for proposed treatment, consider doing DXA and recalculate FRAX.  Tools may underestimate risk if history of multiple fractures, previous vertebral fracture, high dose steroids, other causes of secondary osteoporosis. These tools are meant for adults over 30-40yrs however.

“Intervention thresholds” are NOT covered in guideline, it says see local guidance!

For WOS, no Dexa for coeliac until in 20s.

[NICE osteoporosis guideline ]