March 2006 · Vol. 18, No. 3Bone loss in young women
Whether it is depleted by GnRH agonists, athleticism, or glucocorticoids, swift intervention can often restore BMD
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Fast Track
If a young woman wants to continue a GnRH analogue despite bone loss, add a progestin alone or with conjugated equine estrogen or transdermal estradiol
An estradiol concentration of about 30 pg/mL minimizes bone loss, vasomotor symptoms, and endometriosis lesion activity
The female athlete triad: amenorrhea, disordered eating, and bone loss
Hormonal therapy does not reliably increase BMD in young amenorrheic women with an eating disorder
There may be a risk of fetal harm when pregnancy follows bisphosphonate therapy
Roughly 40% of women taking long-term glucocorticoids are not being monitored for bone loss
Without intervention, young women who begin adulthood with osteoporosis may not achieve optimal bone health
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Robert
L.
Barbieri,
MDEditor-in-Chief, OBG Management Chief, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, and Kate Macy Ladd Professor of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston
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KEY POINTS
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In young women, many cases of osteoporosis are caused by hypoestrogenism resulting from hormone treatment (eg, GnRH agonists, aromatase inhibitors) or lifestyle adaptations (elite athletics, eating disorders).
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Treatment of osteoporosis in young women can often be successful with the use of estrogen or “androgenic” progestins.
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Chronic glucocorticoid treatment is a common cause of clinically significant osteoporosis in young women. Glucocorticoid-induced osteoporosis is an important cause of premenopausal osteoporotic fractures.
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ObGyns play a key role in ensuring that women enter midlife with strong bones. A focus on young women at very high risk for osteoporosis will help to ensure that our patients build their future bone health on a strong foundation.
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ObGyns are very well trained to diagnose and treat women with osteoporosis, most of whom are perimenopausal and menopausal. We are also treating a significant number of young women at risk for osteoporosis because of lifestyle choices or medical treatment of endometriosis or rheumatic diseases. Treatment of this population poses unique challenges and requires specialized approaches.
An important caveat in any discussion of bone loss in young women: Few randomized clinical trials have assessed the efficacy of the various treatments available. In most treatment studies of osteoporosis in young women, bone mineral density (BMD)—an intermediate biometric endpoint—is the primary treatment outcome. In contrast, in the best studies in the menopausal population, the primary treatment outcome is bone fracture—a clinically important endpoint.
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