Osteoporosis in Premenopausal Women: A Clinical Narrative Review by the ECTS and the IOF
- 26 May 2020
- journal article
- review article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 105 (8), 2487-2506
- https://doi.org/10.1210/clinem/dgaa306
Abstract
Context Consensus regarding diagnosis and management of osteoporosis in premenopausal women (PW) is still lacking, due to few studies carried out in this population. Design ECTS and IOF convened a working group to produce an updated review of literature published after 2017 on this topic. Results Fragility fractures in PW are rare and mostly due to secondary osteoporosis, i.e. in presence of an underlying disease such as hormonal, inflammatory or digestive disorders. In absence of another disorder, low bone density (BMD) together with fragility fractures qualifies as “idiopathic osteoporosis”. In contrast, low BMD alone does not necessarily represent osteoporosis in absence of bone microarchitectural abnormalities. BMD increases in PW with osteoporosis when the underlying disease is treated. For example, in celiac disease, an increase of 9% in radius trabecular volumetric density was achieved after 1 year of gluten-free diet, while anti-TNF alfa improved BMD in PW with inflammatory bowel diseases. In amenorrhea, including anorexia nervosa, appropriately delivered estrogen replacement therapy can also improve BMD. Alternatively, antiresorptive or anabolic therapy has been shown to improve BMD in a variety of conditions, the range of improvement (3-16%) depending on skeletal site and the nature of the secondary cause. No studies were powered to demonstrate fracture reduction. The effects of bisphosphonates in childbearing women have been scantly studied and caution is needed. Conclusion The majority of PW with osteoporosis have an underlying disease. Specific therapy of these diseases, as well as antiresorptive and anabolic drugs, improve BMD, but without evidence of fracture reduction.Keywords
This publication has 136 references indexed in Scilit:
- Effect of Alendronate on HIV-Associated Osteoporosis: A Randomized, Double-Blind, Placebo-Controlled, 96-Week Trial (ANRS 120)AIDS Research and Human Retroviruses, 2012
- Abnormal Bone Microarchitecture and Evidence of Osteoblast Dysfunction in Premenopausal Women with Idiopathic OsteoporosisJournal of Clinical Endocrinology & Metabolism, 2011
- Effects of Risedronate and Low-Dose Transdermal Testosterone on Bone Mineral Density in Women with Anorexia Nervosa: A Randomized, Placebo-Controlled StudyJournal of Clinical Endocrinology & Metabolism, 2011
- Zoledronic acid preserves bone mineral density in premenopausal women who develop ovarian failure due to adjuvant chemotherapy: Final results from CALGB trial 79809European Journal Of Cancer, 2011
- Pubertal timing and body mass index gain from birth to maturity in relation with femoral neck BMD and distal tibia microstructure in healthy female subjectsOsteoporosis International, 2011
- Smoking among premenopausal women is associated with increased risk of low bone status: the JPOS StudyJournal of Bone and Mineral Metabolism, 2009
- IGF-1 as an early marker for low bone mass or osteoporosis in premenopausal and postmenopausal womenJournal of Bone and Mineral Metabolism, 2008
- Determinants of Skeletal Loss and Recovery in Anorexia NervosaJournal of Clinical Endocrinology & Metabolism, 2006
- The outcome of pregnancy following pre-pregnancy or early pregnancy alendronate treatmentReproductive Toxicology, 2006
- LRP5 gene polymorphisms and idiopathic osteoporosis in menBone, 2005