Osteoporosis in Premenopausal Women

Abstract

Although osteoporosis occurs most commonly after menopause, premenopausal women can also present with low-trauma fractures or low bone mineral density (BMD). Diagnosis of osteoporosis and management in this population are different than for postmenopausal women. This chapter reviews the definition and epidemiology of premenopausal osteoporosis. It also addresses the interpretation of Dual X-ray Absorptiometry (DXA) results in premenopausal women. Furthermore, it describes normal bone mineral metabolism in young women including peak bone mass accrual and physiological changes of pregnancy and lactation that may affect interpretation of results. Most premenopausal women with osteoporosis have an identifiable and potentially treatable cause of bone fragility. Therefore, a thorough clinical assessment is indicated for women who have unexplained fractures or low BMD. Treatment should focus on the underlying cause. Medications such as bisphosphonates and teriparatide can be recommended for some women with major fragility fractures or an ongoing cause of bone loss. However, there is a dearth of high-quality data on pharmacotherapy for premenopausal osteoporosis, and very few data to address future fracture risk reduction. This chapter reviews data on use of these and other medications for premenopausal osteoporosis in different clinical contexts.