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Premenopausal bone health assessment

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Abstract

The World Health Organization criteria for classification of bone mineral density (BMD) cannot be applied to premenopausal women because the relationship between BMD and fracture risk is not the same as in postmenopausal women. Approximately 2.5% of premenopausal women have BMD that is more than 2.0 standard deviations below the mean BMD of an age-, gender-, and ethnicity-matched reference population. Most premenopausal women with low BMD have low peak bone mass and low 5-to 10-year probability of fracture. The management of these patients involves nonpharmacologic lifestyle measures and reassurances that fracture risk is low. A minority of premenopausal women with low BMD have significant elevation of fracture risk, usually a result of contributing diseases, conditions, or medications that may be identified and treated. Premenopausal women with fractures are at increased risk for postmenopausal osteoporosis and fractures later in life.

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References and Recommended Reading

  1. WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: World Health Organization; 1994.

    Google Scholar 

  2. Melton LJ III, Chrischilles EA, Cooper C, et al.: Perspective. How many women have osteoporosis? J Bone Miner Res 1992, 7:1005–1010.

    Article  PubMed  Google Scholar 

  3. Marshall D, Johnell O, Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996, 312:1254–1259.

    PubMed  CAS  Google Scholar 

  4. Cranney A, Guyatt G, Griffith L, et al.: Summary of metaanalyses of therapies for postmenopausal osteoporosis. Endocr Rev 2002, 23:570–578.

    Article  PubMed  CAS  Google Scholar 

  5. National Osteoporosis Foundation: Physician’s guide to prevention and treatment of osteoporosis. Washington, D.C: National Osteoporosis Foundation; 2003.

    Google Scholar 

  6. Hodgson SF, Watts NB, Bilezikian JP, et al.: American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 2003, 9:544–564.

    PubMed  Google Scholar 

  7. Kanis JA, Gluer CC: An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 2000, 11:192–202.

    Article  PubMed  CAS  Google Scholar 

  8. Kanis JA, Delmas P, Burckhardt P, et al.: Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int 1997, 7:390–406.

    Article  PubMed  CAS  Google Scholar 

  9. Klibanski A, Adams-Campbell L, Bassford T, et al.: Osteoporosis prevention, diagnosis, and therapy. JAMA 2001, 285:785–795.

    Article  Google Scholar 

  10. Leib ES, Lewiecki EM, Binkley N, Hamdy RC: Official positions of the International Society for Clinical Densitometry. J Clin Densitom 2004, 7:1–6. This paper presents the ISCD Official Positions on the diagnosis of osteoporosis in premenopausal women, and is a recommended reference for all clinicians interpreting bone density tests and managing patients in the premenopausal age range.

    Article  PubMed  Google Scholar 

  11. Miller PD, Njeh CF, Jankowski LG, et al.: What are the standards by which bone mass measurement at peripheral skeletal sites should be used in the diagnosis of osteoporosis? J Clin Densitom 2002, 5(Suppl):S39-S45.

    Article  PubMed  Google Scholar 

  12. Lin YC, Lyle RM, Weaver CM, et al.: Peak spine and femoral neck bone mass in young women. Bone 2003, 32:546–553.

    Article  PubMed  Google Scholar 

  13. Looker AC, Wahner HW, Dunn WL, et al.: Proximal femur bone mineral levels of US adults. Osteoporos Int 1995, 5:389–409.

    Article  PubMed  CAS  Google Scholar 

  14. Melton LJ III, Atkinson EJ, O’Connor MK, et al.: Determinants of bone loss from the femoral neck in women of different ages. J Bone Miner Res 2000, 15:24–31.

    Article  PubMed  Google Scholar 

  15. Bainbridge KE, Sowers MF, Crutchfield M, et al.: Natural history of bone loss over 6 years among premenopausal and early postmenopausal women. Am J Epidemiol 2002, 156:410–417.

    Article  PubMed  CAS  Google Scholar 

  16. Slemenda C, Longcope C, Peacock M, et al.: Sex steroids, bone mass, and bone loss. A prospective study of pre-, peri-, and postmenopausal women. J Clin Invest 1996, 97:14–21.

    PubMed  CAS  Google Scholar 

  17. Bastian LA, Smith CM, Nanda K: Is this woman perimenopausal? JAMA 2003, 289:895–902.

    Article  PubMed  Google Scholar 

  18. Recker R, Lappe J, Davies K, Heaney R: Characterization of perimenopausal bone loss: a prospective study. J Bone Miner Res 2000, 15:1965–1973.

    Article  PubMed  CAS  Google Scholar 

  19. Chapurlat RD, Gamero P, Sornay-Rendu E, et al.: Longitudinal study of bone loss in pre-and perimenopausal women: evidence for bone loss in perimenopausal women. Osteoporos Int 2000, 11:493–498.

    Article  PubMed  CAS  Google Scholar 

  20. Hui SL, Slemenda CW, Johnston CC Jr.: Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988, 81:1804–1809.

    PubMed  CAS  Google Scholar 

  21. Kanis JA, Johnell O, Oden A, et al.: Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001, 12:989–995. This paper discusses current concepts on the expression of fracture risk, and provides insight into methodologies that may prove useful in interpreting BMD results in premenopausal women.

    Article  PubMed  CAS  Google Scholar 

  22. Goulding A, Cannan R, Williams SM, et al.: Bone mineral density in girls with forearm fractures. J Bone Miner Res 1998, 13:143–148.

    Article  PubMed  CAS  Google Scholar 

  23. Goulding A, Jones IE, Taylor RW, et al.: More broken bones: a 4-year double cohort study of young girls with and without distal forearm fractures. J Bone Miner Res 2000, 15:2011–2018.

    Article  PubMed  CAS  Google Scholar 

  24. Goulding A, Gold E, Walker R, Lewis-Barned N: Women with past history of bone fracture have low spinal bone density before menopause. N Z Med J 1997, 110:232–233.

    PubMed  CAS  Google Scholar 

  25. Tuppurainen M, Kroger H, Honkanen R, et al.: Risks of perimenopausal fractures—a prospective population-based study. Acta Obstet Gynecol Scand 1995, 74:624–628.

    PubMed  CAS  Google Scholar 

  26. Fiorano-Charlier C, Ostertag A, Aquino JP, et al.: Reduced bone mineral density in postmenopausal women self-reporting premenopausal wrist fractures. Bone 2002, 31:102–106.

    Article  PubMed  CAS  Google Scholar 

  27. Hosmer WD, Genant HK, Browner WS: Fractures before menopause: a red flag for physicians. Osteoporos Int 2002, 13:337–341. This study highlights the clinical importance of recognizing fractures, whether they are in premenopausal or postmenopausal women, as potent risk factors for future adverse skeletal events.

    Article  PubMed  CAS  Google Scholar 

  28. Lauder TD, Dixit S, Pezzin LE, et al.: The relation between stress fractures and bone mineral density: evidence from active-duty Army women. Arch Phys Med Rehabil 2000, 81:73–79.

    PubMed  CAS  Google Scholar 

  29. Lauridsen AL, Vestergaard P, Hermann AP, et al.: Female premenopausal fracture risk is associated with gc phenotype. J Bone Miner Res 2004, 19:875–881.

    Article  PubMed  Google Scholar 

  30. Dent CE: Keynote Address: Problems in Metabolic Bone Disease. Proceedings of the International Symposium on Clinical Aspects of Metabolic Bone Disease 1973, 1–7.

  31. Kanis JA: Osteoporosis and its consequences. In Osteoporosis. Edited by Kanis JA. Oxford: Blackwell Science, Ltd.; 1994.

    Google Scholar 

  32. Pocock NA, Eisman JA, Hopper JL, et al.: Genetic determinants of bone mass in adults. A twin study. J Clin Invest 1987, 80:706–710.

    Article  PubMed  CAS  Google Scholar 

  33. Peris P, Guanabens N, Martinez de Osaba MJ, et al.: Clinical characteristics and etiologic factors of premenopausal osteoporosis in a group of Spanish women. Semin Arthritis Rheum 2002, 32:64–70.

    Article  PubMed  Google Scholar 

  34. Fasano A, Berti I, Gerarduzzi T, et al.: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003, 163:286–292.

    Article  PubMed  Google Scholar 

  35. Zipfel S, Seibel MJ, Lowe B, et al.: Osteoporosis in eating disorders: a follow-up study of patients with anorexia and bulimia nervosa. J Clin Endocrinol Metab 2001, 86:5227–5233.

    Article  PubMed  CAS  Google Scholar 

  36. Lucas AR, Melton LJ III, Crowson CS, O’Fallon WM: Long-term fracture risk among women with anorexia nervosa: a population-based cohort study. Mayo Clin Proc 1999, 74:972–977.

    PubMed  CAS  Google Scholar 

  37. Ott SM, Scholes D, LaCroix AZ, et al.: Effects of contraceptive use on bone biochemical markers in young women. J Clin Endocrinol Metab 2001, 86:179–185.

    Article  PubMed  CAS  Google Scholar 

  38. Berenson AB, Radecki CM, Grady JJ, et al.: A prospective, controlled study of the effects of hormonal contraception on bone mineral density. Obstet Gynecol 2001, 98:576–582.

    Article  PubMed  CAS  Google Scholar 

  39. Cundy T, Cornish J, Roberts H, et al.: Spinal bone density in women using depot medroxyprogesterone contraception. Obstet Gynecol 1998, 92:569–573.

    Article  PubMed  CAS  Google Scholar 

  40. Scholes D, LaCroix AZ, Ichikawa LE, et al.: A prospective evaluation of the effects on bone of discontinuing depot medroxyprogesterone acetate contraception. J Bone Miner Res 1999, 14(Suppl 1):S384.

    Google Scholar 

  41. Powles TJ, Hickish T, Kanis JA, et al.: Effect of tamoxifen on bone mineral density measured by dual-energy x-ray absorptiometry in healthy premenopausal and postmenopausal women. J Clin Oncol 1996, 14:78–84.

    PubMed  CAS  Google Scholar 

  42. Uemura T, Mohri J, Osada H, et al.: Effect of gonadotropinreleasing hormone agonist on the bone mineral density of patients with endometriosis. Fertil Steril 1994, 62:246–250.

    PubMed  CAS  Google Scholar 

  43. Agarwal SK: Impact of six months of GnRH agonist therapy for endometriosis. Is there an age-related effect on bone mineral density? J Reprod Med 2002, 47:530–534.

    PubMed  CAS  Google Scholar 

  44. Farhat G, Yamout B, Mikati MA, et al.: Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology 2002, 58:1348–1353.

    PubMed  CAS  Google Scholar 

  45. Liporace J, D’Abreu A: Epilepsy and women’s health: family planning, bone health, menopause, and menstrual-related seizures. Mayo Clin Proc 2003, 78:497–506.

    Article  PubMed  Google Scholar 

  46. van Staa TP, Leufkens HGM, Cooper C: The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 2002, 13:777–787.

    Article  PubMed  Google Scholar 

  47. Saag KG, Emkey R, Schnitzer TJ, et al.: Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 1998, 339:292–299.

    Article  PubMed  CAS  Google Scholar 

  48. Cohen S, Levy RM, Keller M, et al.: Risedronate therapy prevents corticosteroid-induced bone loss—a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 1999, 42:2309–2318.

    Article  PubMed  CAS  Google Scholar 

  49. Adachi JD, Bensen WG, Brown J, et al.: Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med 1997, 337:382–387.

    Article  PubMed  CAS  Google Scholar 

  50. Steinbuch M, Youket TE, Cohen S: Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 2004, 15:323–328.

    Article  PubMed  CAS  Google Scholar 

  51. Mathias S, Nayak US, Isaacs B: Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil 1986, 67:387–389.

    PubMed  CAS  Google Scholar 

  52. Finkelstein JS, Lee MLT, Sowers M, et al.: Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 2002, 87:3057–3067.

    Article  PubMed  CAS  Google Scholar 

  53. Wolff I, van Croonenborg JJ, Kemper HC, et al.: The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre-and postmenopausal women. Osteoporos Int 1999, 9:1–12.

    Article  PubMed  CAS  Google Scholar 

  54. Sategna-Guidetti C, Grosso SB, Grosso S, et al.: The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients. Aliment Pharmacol Ther 2000, 14:35–43.

    Article  PubMed  CAS  Google Scholar 

  55. Rauch F, Plotkin H, Zeitlin L, Glorieux FH: Bone mass, size, and density in children and adolescents with osteogenesis imperfecta: effect of intravenous pamidronate therapy. J Bone Miner Res 2003, 18:610–614.

    Article  PubMed  CAS  Google Scholar 

  56. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis: Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum 2001, 44:1496–1503.

    Article  Google Scholar 

  57. Gambacciani M, Ciaponi M, Cappagli B, et al.: Longitudinal evaluation of perimenopausal femoral bone loss: effects of a low-dose oral contraceptive preparation on bone mineral density and metabolism. Osteoporos Int 2000, 11:544–548.

    Article  PubMed  CAS  Google Scholar 

  58. Shargil AA: Hormone replacement therapy in perimenopausal women with a triphasic contraceptive compound: a three-year prospective study. Int J Fertil 1985, 30:15–28.

    PubMed  CAS  Google Scholar 

  59. Pasco JA, Kotowicz MA, Henry MJ, et al.: Oral contraceptives and bone mineral density: a population-based study. Am J Obstet Gynecol 2000, 182:265–269.

    Article  PubMed  CAS  Google Scholar 

  60. Prior JC, Kirkland SA, Joseph L, et al.: Oral contraceptive use and bone mineral density in premenopausal women: cross-sectional, population-based data from the Canadian Multicentre Osteoporosis Study. Can Med Assoc J 2001, 165:1023–1029.

    CAS  Google Scholar 

  61. Michaelsson K, Baron JA, Farahmand BY, et al.: Oralcontraceptive use and risk of hip fracture: a case-control study. Lancet 1999, 353:1481–1484.

    Article  PubMed  CAS  Google Scholar 

  62. Cooper C, Hannaford P, Croft P, Kay CR: Oral contraceptive pill use and fractures in women: a prospective study. Bone 1993, 14:41–45.

    Article  PubMed  CAS  Google Scholar 

  63. Golden NH, Lanzkowsky L, Schebendach J, et al.: The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa. J Pediatr Adolesc Gynecol 2002, 15:135–143.

    Article  PubMed  Google Scholar 

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  1. New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, 87106, Albuquerque, NM, USA

    E. Michael Lewiecki MD, FACP

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Lewiecki, E.M. Premenopausal bone health assessment. Curr Rheumatol Rep 7, 46–52 (2005). https://doi.org/10.1007/s11926-005-0008-9

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