Premenopausal osteoporosis

Abstract

In premenopausal women, bone mineral density measurement by dual-energy X-ray absorptiometry should not be used as the sole guide for diagnosis or treatment of osteoporosis, universal screening with bone mineral density is not advised and the World Health Organization classification of bone status should not be applied. A diagnosis of premenopausal osteoporosis is reserved for those with evidence of fragility and may also be considered in women with low bone mass and an ongoing secondary cause of osteoporosis. Idiopathic osteoporosis in young women is rare. A thorough evaluation of secondary causes is indicated in all patients, with glucocorticoid treatment a common secondary cause of low bone mass and osteoporosis. Hypoestrogenism may be the primary cause of low bone mass and contribute to excessive bone loss in many conditions associated with premenopausal osteoporosis, and should be treated unless contra-indicated. The mainstay of treatment in premenopausal females with low bone mass includes risk factor reduction, advocating a healthy, active lifestyle and optimal treatment of secondary causes of bone loss. The safety of bone-specific therapy, especially long term and during pregnancy, remains uncertain. Bisphosphonates, teriparatide, denosumab and estrogen treatment increase bone density in premenopausal women with osteoporosis, but there are no study data confirming short-term fracture prevention with use of these agents.

绝经前骨质疏松症 摘要

对于绝经前女性, 双能X线骨密度测量不应作为骨质疏松诊断或治疗的唯一指南, 不建议进行骨密度的普遍筛查, 也不应采用世界卫生组织的骨状况分级。有脆性骨折证据者可诊断为绝经前骨质疏松, 骨量减少以及持续存在骨质疏松的继发病因者也应考虑在内。特发性骨质疏松在年轻女性中罕见。对次要原因的全面评估适用于所有患者, 糖皮质激素治疗是骨量减少和骨质疏松症的常见次要原因。在许多与绝经前骨质疏松相关的原因 中, 雌激素缺乏可能是造成低骨量的主要原因, 会造成骨量的过度丢失, 除非禁忌, 否则应予以治疗。绝经前女性骨量减少患者的治疗主要包括降低危险因素、倡导健康积极的生活方式以及对继发骨量丢失的原因进行优化治疗。骨特异性治疗的安全性, 特别是长期和怀孕期间, 仍然不确定。双膦酸盐、特立帕肽、地诺沙布和雌激素治疗可增加绝经前骨质疏松女性的骨密度, 但尚无研究证实这些药物可在短期内预防骨折。

Keywords:

• Premenopausal osteoporosis
• bone mass density
• fragility fractures
• secondary causes
• bisphosphonates

Potential conflict of interest

No potential conflict of interest was reported by the author(s).

Source of funding

Nil.