Osteoporosis International

, Volume 23, Issue 12, pp 2735–2748

Osteoporosis in young adults: pathophysiology, diagnosis, and management


    • Division of Bone Diseases, Faculty of MedicineGeneva University Hospital
  • M. L. Bianchi
    • Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS
  • J. A. Eisman
    • Garvan Institute of Medical Research, St Vincent’s HospitalUniversity of New South Wales
  • A. J. Foldes
    • Osteoporosis CenterHadassah University Hospital
  • S. Adami
    • Rheumatology UnitUniversity of Verona
  • D. A. Wahl
    • International Osteoporosis Foundation
  • J. J. Stepan
    • Institute of Rheumatology and Department of Rheumatology, Faculty of MedicineCharles University
  • M.-C. de Vernejoul
    • Federation of Rheumatology, Hospital LariboisièreUniversity Paris 7
  • J.-M. Kaufman
    • Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone DiseasesGhent University Hospital
  • For the IOF Committee of Scientific Advisors Working Group on Osteoporosis Pathophysiology

DOI: 10.1007/s00198-012-2030-x

Cite this article as:
Ferrari, S., Bianchi, M.L., Eisman, J.A. et al. Osteoporos Int (2012) 23: 2735. doi:10.1007/s00198-012-2030-x


Postmenopausal osteoporosis is mainly caused by increased bone remodeling resulting from estrogen deficiency. Indications for treatment are based on low areal bone mineral density (aBMD, T-score ≤ −2.5), typical fragility fractures (spine or hip), and more recently, an elevated 10-year fracture probability (by FRAX®). In contrast, there is no clear definition of osteoporosis nor intervention thresholds in younger individuals. Low aBMD in a young adult may reflect a physiologically low peak bone mass, such as in lean but otherwise healthy persons, whereas fractures commonly occur with high-impact trauma, i.e., without bone fragility. Furthermore, low aBMD associated with vitamin D deficiency may be highly prevalent in some regions of the world. Nevertheless, true osteoporosis in the young can occur, which we define as a T-score below −2.5 at spine or hip in association with a chronic disease known to affect bone metabolism. In the absence of secondary causes, the presence of fragility fractures, such as in vertebrae, may point towards genetic or idiopathic osteoporosis. In turn, treatment of the underlying condition may improve bone mass as well. In rare cases, a bone-specific treatment may be indicated, although evidence is scarce for a true benefit on fracture risk. The International Osteoporosis Foundation (IOF) convened a working group to review pathophysiology, diagnosis, and management of osteoporosis in the young, excluding children and adolescents, and provide a screening strategy including laboratory exams for a systematic approach of this condition.


DiagnosisIOFLow bone massOsteoporosisSecondary osteoporosisYoung adults

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© International Osteoporosis Foundation and National Osteoporosis Foundation 2012