Premenopausal women and low bone density.

OBJECTIVE To review the evidence and provide an approach to management of low bone density among premenopausal women. QUALITY OF EVIDENCE MEDLINE: was searched from January 1990 to November 2004 and articles graded by level of evidence (I to III). Diagnosis and management recommendations were based on evidence from randomized controlled trials and expert consensus.

MAIN MESSAGE Bone mineral density (BMD) testing among premenopausal women should be completed only in the presence of approved indications. Current evidence does not support screening for osteoporosis among premenopausal women. Low BMD in premenopausal women is associated with a lower fracture risk than seen in postmenopausal women. In the absence of fragility fractures, low BMD might reflect low peak bone mass based on genetic predisposition, environment, and lifestyle factors. Clinical evaluation enables distinction between low peak bone mass and a systemic disorder resulting in low BMD and skeletal fragility. Common causes of low bone density among premenopausal women include ovulatory disturbances and low body weight.

CONCLUSION Bone mineral density alone is insufficient for diagnosis of osteoporosis among premenopausal women in the absence of fragility fractures. Antiresorptive therapy has been evaluated and shown to benefit premenopausal women using glucocorticoid therapy or those with primary hyperparathyroidism.