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Premenopausal women with idiopathic low-trauma fractures and/or low bone mineral density

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Abstract

Introduction

In men, idiopathic osteoporosis (IOP) is often associated with low serum insulin-like growth factor (IGF-1) and reduced bone formation. The characteristics of premenopausal women with IOP are not well defined. We aimed to define the clinical, reproductive, and biochemical characteristics of premenopausal women with unexplained osteoporosis.

Methods

This is a cross-sectional study of 64 women with unexplained osteoporosis, 45 with fragility fractures, 19 with low bone mineral density (BMD; Z-score less than or equal to −2.0) and 40 normal controls. The following are the main outcome measures: clinical and anthropometric characteristics, reproductive history, BMD, gonadal and calciotropic hormones, IGF-1, and bone turnover markers (BTMs).

Results

Subjects had lower BMI and BMD than controls, but serum and urinary calcium, serum estradiol, vitamin D metabolites, IGF-1, and most BTMs were similar. Serum parathyroid hormone (PTH) and the resorption marker, tartrate-resistant acid phosphatase (TRAP5b), were significantly higher in both groups of subjects than controls and directly associated in all groups. Serum IGF-1 and all BTMs were directly associated in controls, but the association was not significant after controlling for age. There was no relationship between serum IGF-1 and BTMs in subjects. There were few differences between women with fractures and low BMD.

Conclusions

Higher serum TRAP5b and PTH suggest that increased bone turnover, possibly related to subclinical secondary hyperparathyroidism could contribute to the pathogenesis of IOP. The absence of differences between women with fractures and those with very low BMD indicates that this distinction may not be clinically useful to categorize young women with osteoporosis.

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Acknowledgment

These studies are supported by the following NIH funding sources: RO1AR49896 (E.S.), K24 AR052661 (E.S.), K23 AR054127 (A.C.), and UL1 RR024156 (S.C.).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Columbia University, New York, NY, USA

    A. Cohen, D. W. Dempster, S. Cremers, D. J. McMahon, E. M. Stein, J. Fleischer, H. Rogers, R. B. Staron & E. Shane

  2. Creighton University, Omaha, NE, USA

    R. R. Recker, J. Lappe & J. LeMaster

  3. Helen Hayes Hospital, West Haverstraw, NY, USA

    D. W. Dempster

  4. Maine Medical Center, Portland, ME, USA

    C. J. Rosen

  5. Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8-864, 630 West 168th Street, New York, 10032, NY, USA

    A. Cohen

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  1. A. Cohen
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Correspondence to A. Cohen.

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Cohen, A., Recker, R.R., Lappe, J. et al. Premenopausal women with idiopathic low-trauma fractures and/or low bone mineral density. Osteoporos Int 23, 171–182 (2012). https://doi.org/10.1007/s00198-011-1560-y

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  • DOI: https://doi.org/10.1007/s00198-011-1560-y

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