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Osteoporosis International

, Volume 23, Issue 12, pp 2735–2748 | Cite as

Osteoporosis in young adults: pathophysiology, diagnosis, and management

  • S. Ferrari
  • M. L. Bianchi
  • J. A. Eisman
  • A. J. Foldes
  • S. Adami
  • D. A. Wahl
  • J. J. Stepan
  • M.-C. de Vernejoul
  • J.-M. Kaufman
  • For the IOF Committee of Scientific Advisors Working Group on Osteoporosis Pathophysiology
Review

Abstract

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.

Keywords

Diagnosis IOF Low bone mass Osteoporosis Secondary osteoporosis Young adults 

Notes

Acknowledgments

We thank P. Devogelaer, C. Gluer, E. Orwoll, P. Miller, and other IOF CSA members for their valuable comments on the manuscript, as well as D. Pierroz for her editorial assistance.

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • S. Ferrari
    • 1
  • M. L. Bianchi
    • 2
  • J. A. Eisman
    • 3
  • A. J. Foldes
    • 4
  • S. Adami
    • 5
  • D. A. Wahl
    • 6
  • J. J. Stepan
    • 7
  • M.-C. de Vernejoul
    • 8
  • J.-M. Kaufman
    • 9
  • For the IOF Committee of Scientific Advisors Working Group on Osteoporosis Pathophysiology
  1. 1.Division of Bone Diseases, Faculty of MedicineGeneva University HospitalGenevaSwitzerland
  2. 2.Bone Metabolism Unit, Istituto Auxologico Italiano IRCCSMilanItaly
  3. 3.Garvan Institute of Medical Research, St Vincent’s HospitalUniversity of New South WalesSydneyAustralia
  4. 4.Osteoporosis CenterHadassah University HospitalJerusalemIsrael
  5. 5.Rheumatology UnitUniversity of VeronaVeronaItaly
  6. 6.International Osteoporosis FoundationNyonSwitzerland
  7. 7.Institute of Rheumatology and Department of Rheumatology, Faculty of MedicineCharles UniversityPragueCzech Republic
  8. 8.Federation of Rheumatology, Hospital LariboisièreUniversity Paris 7ParisFrance
  9. 9.Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone DiseasesGhent University HospitalGhentBelgium

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