Which of the following is a secondary cause of osteoporosis that clinicians should consider?

• A. Chronic glucocorticoid use
• B. Adequate nutrition
• C. Regular sun exposure
• D. Regular physical activity

Answer: (B)

A medication-related factor is the most important clue that osteoporosis can be secondary to another condition or treatment. Chronic glucocorticoid therapy is a well-known secondary cause because steroids directly disrupt bone remodeling: they suppress osteoblast activity (bone formation), prolong osteoclast survival (bone resorption), and reduce calcium absorption while increasing urinary calcium loss. This combination leads to rapid bone loss and higher fracture risk, independent of age.

In contrast, adequate nutrition provides the body with calcium, vitamin D, and protein—the building blocks for healthy bone; regular sun exposure supports vitamin D synthesis; and regular weight-bearing physical activity stimulates bone formation and helps maintain or increase bone density. These factors strengthen bone rather than cause osteoporosis. So, when evaluating osteoporosis risk, a history of long-term glucocorticoid use points to a secondary cause, while good nutrition, sun exposure, and exercise are protective considerations.