Bone Abstracts

Low bone density in younger women is often due to underlying conditions such as eating disorders, premature ovarian failure or glucocorticoid treatment. It may also be due to genetically low peak bone mass.

In general, absolute fracture risk in young women is low, even in the context of low bone density. Management should begin with treatment of underlying causes where possible, and lifestyle modification where appropriate.

The evidence base for the pharmacological treatment of young women is quite limited.

In women who undergo early menopause, many clinicians would recommend oestrogen replacement until the usual age of menopause, but there is uncertainty as to the best form of oestrogen replacement.

There have been several clinical trials in anorexia nervosa. Combined treatment approaches with transdermal or oral oestrogen and DHEAS or IGF1 may be effective and are attractive because they aim to decrease bone resorption and increase bone formation.

In glucocorticoid-induced osteoporosis there is some evidence for the use of bisphosphonates or teriparatide in young women.

It is important to consider potential pregnancies when treating women of child-bearing age, and there are case reports of congenital malformations and neonatal hypocalcaemia in association with bisphosphonates during pregnancy. Bisphosphonates which may have a quicker offset of action may be preferable in young women. Patients should be informed if use of osteoporosis drugs is outside the licence.

In general, pharmacological treatment of osteoporosis in young women should be reserved for women at high current fracture risk.