Osteoporosis in Premenopausal Women

Abstract

Fragility fractures in premenopausal women are rare and often due to secondary osteoporosis caused by hormonal, inflammatory, or digestive disorders or treatments. Idiopathic, premenopausal osteoporosis is defined as low bone density with prevalent fragility fractures.

Investigations include obtaining a thorough medical history and performing biochemical evaluation to exclude causes of secondary osteoporosis. Screening for genetic causes is recommended when there is a strong suspicion of a heritable component based on family history or additional clinical features suggestive of genetic disease.

In women with secondary osteoporosis, BMD increases when the underlying disease is treated. Antiresorptive as well as bone anabolic therapies have been shown to improve BMD. The improvement depends on the skeletal site and the nature of the secondary cause. No studies have been powered to demonstrate fracture risk reduction.

Conclusion: The majority of premenopausal women with osteoporosis have an underlying disease. Specific therapy of these diseases, as well as antiresorptive and bone anabolic treatments, improve bone density, but there is currently no evidence of fracture risk reduction.