Premature ovarian failure is associated with bone loss and increased fracture risk. Additionally, illnesses or medications that have led to premature ovarian failure may also have consequences for bone health. In some cases, if there are no contraindications, estrogen can be used to prevent bone loss in this setting. When estrogen is contraindicated, bisphosphonates are sometimes considered. The choice of bisphosphonates in younger women must take into account our increasing concerns about the potential risks of long-term use of these agents. In young women, plans for duration of bisphosphonate use should be discussed as part of the process of initiation of this therapy. More research is needed to better understand the potential risks of these medications.View Thread
There is less information available about treatment options for premenopausal women than for postmenopausal women with osteoporosis, because the condition is uncommon. There is also very little data available to guide us in making decisions about which drugs to use (if any) after a course of teriparatide (Forteo) in a young woman. The potential benefits and risks of bisphosphonate use may be quite different in premenopausal women compared to postmenopausal women.
Alendronate (Fosamax) and risedronate (Actonel) have been approved by the U.S. Food and Drug Administration (FDA) for use in certain premenopausal women taking steroid medicines such as prednisone and cortisone. However, because of toxic effects in pregnant animals, these medicines carry a Category C rating for safety in pregnancy from the FDA. Since bisphosphonates may remain in the skeleton for years, it should be kept in mind that there is also the potential for adverse effects after stopping bisphosphonates. In general, medications for osteoporosis should be used with great caution in premenopausal women because less information is known about how they will affect young women in the short and long term.View Thread
Pregnancy and breastfeeding are both known to be associated with decreases in bone density that are followed by recovery. However, when bone density remains below the expected range for age, or when there is a history of low trauma fracture, a thorough evaluation for additional secondary causes of bone loss and bone fragility should be considered.
Because your daughter is a teenager, it most appropriate to use the Z score, not the T score, when interpreting her bone density results. A Z-score of -2.8 is, by definition, lower than expected for her age. An evaluation for causes of osteoporosis and bone loss could help to better define the type of bone problem she might have and can help to guide future management. Some causes of low bone density in this age group could be treated or corrected leading to an improvement in bone health. If nutritional deficiencies or estrogen deficiency/loss of periods are thought to be contributing to the low bone density, then therapy could be aimed at correcting these problems. Further evaluation could also help to guide recommendations for vitamin use and calcium supplements. Based on one bone density test, it is difficult to know whether your daughter is appropriately gaining bone or even currently losing bone, so a repeat bone density test in 1-2 years will be an important part of the plan, as well.
In addition, the following two resources may be helpful to you and your daughter:
Since your daughter has not yet reached menopause, the Z-score, not the T-score, should be used to assess her bone density. T-scores are only used in postmenopausal women and men age 50 and older. A Z-score of -2.0 or lower is considered below the expected norm for a premenopausal woman's age. While your daughter's score is near -2.0, her score of -1.9 still falls into the category of normal (within expected range for age) for a premenopausal woman. Diagnosing osteoporosis in premenopausal women is not straightforward and can be quite complicated. The diagnosis would need to be based on other parts of a young woman's medical history, and not only on bone density. Because your daughter is so young, she may not have reached her peak bone mass yet and still may experience increases in bone density until around the age of 25. Some premenopausal women have low bone density because their genes (family history) caused them to have low peak bone mass. Other young women have an additional cause or condition that could lead to bone loss. * Now is a good time to make sure your daughter is getting enough calcium, vitamin D and exercise to protect her bones. Not smoking or drinking too much alcohol is also important. You and your daughter can also get more information from her doctor about any other tests or follow-up that may be appropriate for her at this time and in the future. For more information on this topic, please visit http://www.nof.org/aboutosteoporosis/whatwomencando/youngadultwomenView Thread
All of the factors that you are considering, including nutrition, estrogen, calcium, vitamin D and exercise, are important for bone health. Both nutritional issues and amenorrhea (absence of menstrual periods for several months in a row) may be important causes of osteoporosis and/or bone loss. A knowledgeable doctor will be able to advise you as to what measures you should take to protect your bones, taking into consideration your medical history, family history and other important factors that are unique to you.
The National Osteoporosis Foundation can also supply you with free information about low bone density in younger women, nutrition, and other topics related to bone health. You can request this information by calling 1-800-223-9994 or visiting www.nof.org and clicking on "Patient Info" and "Request Information."
Evaluation of bone health in a young woman should take into account reproductive history since pregnancy and lactation both have effects on bone metabolism and bone density. Because of the calcium demands of milk production, breastfeeding is associated with an expected, reversible loss of bone. Recovery of bone density has been shown beginning 6-12 months postpartum and may continue for months thereafter. Bone density tests done in the context of breastfeeding or soon after weaning should be interpreted with these expected changes in mind, since improvement in bone density may be expected in the future. All women who are pregnant or nursing need to get enough calcium, vitamin D and appropriate exercise to keep their bones healthy (see www.nof.org for NOF's recommendations).
Decisions about treatment for osteoporosis in a premenopausal woman must be made on an individualized basis that takes into account risks of fracture and bone loss, as well as potential risks and side effects of the medications. There is less information available about treatment options for premenopausal women than for postmenopausal women with osteoporosis, because the condition is uncommon. In general, medications for osteoporosis should be used with caution in premenopausal women because less information is known about how they will affect young women in the short and long term.
A further discussion might be found in: Should bisphosphonates be used in premenopausal women? Cohen A. Maturitas. 2010 May;66(1):3-4. Epub 2010 Mar 30.View Thread
It is quite unexpected and rare for a premenopausal woman to receive a diagnosis of osteoporosis or be found to have bone loss. This diagnosis should lead to a careful evaluation to search for possible causes of bone fragility and/or bone loss. The majority of premenopausal women thus evaluated can be found to have a cause, and in many cases, identification of a contributing condition can help to guide management of the affected individual.
There is less information available about treatment options for premenopausal women than for postmenopausal women with osteoporosis, because the condition is uncommon. In general, medications for osteoporosis should be used with caution in premenopausal women because less information is known about how they will affect young women in the short and long term. Because the diagnosis of unexplained osteoporosis is so rare in young/premenopausal women, those who receive such a diagnosis might also consider participation in research to help all of us learn more about the condition and about treatment options. For information about research protocols available, visit clinicaltrials.gov.View Thread
It is possible for a premenopausal woman to be diagnosed with osteoporosis, but making this diagnosis is challenging. Osteoporosis could be diagnosed in a person with a history of low trauma fracture(s). The diagnosis could also be made if a person's low bone density is associated with a known disease or condition that is associated with bone loss or fractures. Unlike in postmenopausal women, bone density alone cannot be used to diagnose osteoporosis or osteopenia (low bone density) in premenopausal women.
The majority of premenopausal women with osteoporosis are found, after detailed evaluation, to have a medical condition or medication exposure that has contributed to their bone disorder. Seeing your healthcare provider to initiate such an evaluation is a good first step to take. Your other medical issues may or may not be related to a cause of your low bone density.
Your knowledgeable healthcare provider can help to determine whether or not you have osteoporosis, what the causes could be, and what steps you could take to protect your bones.View Thread
People with inflammatory bowel disease, like Crohn's, often have trouble absorbing calcium, vitamin D and other nutrients for bone health and overall health. These individuals are therefore at risk of bone loss and osteoporosis. Taking 5 mg or more of steroids daily for 3 or more months significantly increases these risks. If you need to take steroids, NOF recommends taking the lowest dose possible for the shortest period of time necessary to control your symptoms.
The symptoms you describe could be related to other medical conditions besides osteoporosis. You should discuss these symptoms with your healthcare provider. Since you have risk factors for osteoporosis, you should also ask your doctor about having a bone density test. It is also important to have your vitamin D levels tested to make sure your body has enough vitamin D for your bone health. This test measures 25-hydroxyvitamin D, which is also written as 25(OH)D.
Finally, it's important to work with your healthcare provider to make sure you're doing everything you can to protect your bones. This includes getting enough calcium, vitamin D and exercise for bone health as well as not smoking or drinking too much alcohol. If you have osteoporosis, you and your healthcare provider should develop a treatment plan to prevent broken bones (fractures).View Thread