Osteoporosis in Premenopausal Women: A Clinical Narrative Review by the ECTS and the IOF

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Context</jats:title> <jats:p>Consensus regarding diagnosis and management of osteoporosis in premenopausal women (PW) is still lacking due to few studies carried out in this population.</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>The European Calcified Tissue Society and the International Osteoporosis Foundation convened a working group to produce an updated review of literature published after 2017 on this topic.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Fragility fractures in PW are rare and mostly due to secondary osteoporosis (ie, in presence of an underlying disease such as hormonal, inflammatory, or digestive disorders). In absence of another disorder, low bone mineral 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-tumor necrosis factor alpha 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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>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.</jats:p> </jats:sec>

Updated guidance on the management of cancer treatment-induced bone loss (CTIBL) in pre- and postmenopausal women with early-stage breast cancer

“…Based on expert opinion, we propose that these women should be offered a baseline fracture risk assessment with evaluation of risk factors and BMD measurement with DXA and VFA. Anti-resorptive therapy can be considered if a Z-score is ≤ -2.0 SD or if a Z-score is between −1.0 and −2.0 and fragility fractures have been reported [92] . Still, dedicated RCTs with a long follow-up are needed in pre-MP women on TAM while it will remain difficult to precisely evaluate anti-fracture benefits in these women due to low fracture incidence.…”

Management of glucocorticoid-induced osteoporosis

“…However, on the other hand, fracture risk is extremely high in elderly women with GC use and an underlying inflammatory disease, and thus a relative risk reduction of 50-75% of vertebral fractures corresponds with a large reduction in absolute risk. In addition, in postmenopausal women a reduction in fractures was already demonstrated 6 months after initiating alendronate [80]. In other words, the elderly individuals treated with GCs y are the preferred target group for antiosteoporotic drugs.…”

Association between vitamin D receptor gene polymorphism and osteoporotic fractures among type II diabetic Egyptian females

“…A previous Egyptian study concluded that TaqI rs731236 has no influence on the risk of T2DM (14) . Moreover, premenopausal osteoporosis and osteoporotic fractures are rare and it occurs often as a secondary disease (18,19) . Accordingly, we aimed to study the influence of VDR TaqI rs731236 A>G on osteoporotic fracture as T2DM complication in Egyptian premenopausal adult females who are matched in their age and socioeconomic status.…”