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In a series of 214 women with vertebral crush fractures, 119 (55.6%) were found to have either an underlying secondary cause of osteoporosis or an early menopause before the age of 45 or both. A secondary cause of osteoporosis was present in 65 women (30.4%), the most common of which was corticosteroid therapy (13.6%) followed by previous or present hyperthyroidism (7.5%). Seventy-eight women (36.4%) had undergone menopause before the age of 45, occurring naturally in 55 (25.7%) and after surgery in 23 women (10.7%). We conclude that secondary osteoporosis and early menopause are major causes of vertebral crush fractures in women. We suggest that wider use of hormone replacement therapy following early menopause and prompt recognition and treatment of secondary causes of osteoporosis may reduce the risk of vertebral crush fractures in women.