Article

Management of low bone mineral density in premenopausal women.

McMaster University, Department of Medicine, Hamilton ON.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 05/2005; 27(4):345-9.
Source: PubMed

ABSTRACT To review evidence for management of low bone density in premenopausal women and to establish practical guidelines for management of low bone density in this population by family physicians.
A search of MEDLINE for relevant articles published between January 1990 and May 2004 was conducted. Articles retrieved were graded by level of evidence. Recommendations for diagnosis and therapy were based on evidence from randomized controlled trials and expert consensus.
Low bone density in premenopausal women is not associated with the same increased risk of fracture seen in older women. In the absence of fragility fractures and loss of height, it may be a reflection of low peak bone mass and may represent the normal variation in bone mineral density (BMD). Women may have low bone density secondary to an underlying skeletal or systemic disorder. Common causes of low bone density in premenopausal women include ovulatory disturbances and low body weight.
Osteoporosis is diagnosed in the premenopausal female population in the presence of fragility fractures and is not based solely on the results of BMD testing. Secondary causes of bone loss should be excluded, and any underlying condition contributing to low bone density should be corrected. Antiresorptive therapy has been evaluated only in those premenopausal women who are on glucocorticoid therapy and in those with primary hyperparathyroidism. Only in these conditions has antiresorptive therapy been shown to improve BMD.

0 Followers
 · 
106 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bone marrow edema (BME) of the foot and ankle is a common finding. Based on the causative factors, this condition can be classified into four different groups: mechanical, reactive, ischemic and metabolic BME. Mechanical BME: “Bone bruises”, trabecular fractures, micro fractures and stress fractures. Ischemic BME: osteochondritis dissecans, osteonecrosis. Reactive BME: degenerative or inflammatory arthritis, tendonitis, tumorous lesions, postoperative conditions. Metabolic BME: Transient osteoporosis (syn. bone marrow edema syndrome). The understanding of the causative factors is mandatory to develop a strategy for treatment. Mechanical BME caused by overuse or acute trauma are the most frequent findings in sports. Subtle injuries of the trabecular bone are often not visible on MRI, but can become apparent on high resolution CT. Close co-operation with the radiologist is mandatory to make a precise diagnosis. Nonweight bearing in addition to analgesics and physiotherapy are the major principles in the treatment. However, if possible, local overload or a hind foot malalignment should be reduced by insoles. The off-label use of ilomedin or bisphosphonates can be helpful, although there is still a lack of scientific evidence.ZusammenfassungKnochenmarködeme (KME) an Fuß und Sprunggelenk sind ein häufiger Befund. Basierend auf den zugrundeliegenden Pathomechanismen lassen sich Knochenmarködeme in vier Gruppen klassifizieren: Mechanisch induzierte, reaktive, ischämische und metabolische Knochenmarködeme. Die mechanisch induzierten KME umfassen Diagnosen wie das „Bone bruise”, trabekuläre Frakturen und Mikrofrakturen sowie die Stressfrakturen. Ischämisch bedingte KME sind die Osteochondrosis dissecans und die Osteonekrose. Reaktive KME entstehen auf der Basis degenerativer oder entzündlicher Gelenkerkrankungen sowie postoperativ oder bei Weichteilaffektionen. Die transiente Osteoporose (Syn. Knochenmarködem-Syndrom) ist aufgrund histologischer Daten als metabolisches KME einzustufen. Das Verständnis der zugrundeliegenden Pathologie ist der Schlüssel zur Behandlung der Erkrankung. Im Bereich des Sports finden sich überwiegend mechanisch induzierte KME. Dabei sind diskrete trabekuläre Frakturen auf den MRT-Aufnahmen nicht sichtbar, können aber mit Hilfe der hochauflösenden CT dargestellt werden. Die enge Kooperation mit dem Radiologen ist für eine exakte Diagnose von entscheidender Bedeutung. Entlastung in Kombination mit Analgetika und Physiotherapie sind die Grundprinzipien der Behandlung. Wenn möglich sollten Fußfehlstellungen durch Einlagen korrigiert werden. Der „off label” Gebrauch von Ilomedin oder Bisphosphonaten kann hilfreich sein, eine abschließende wissenschaftliche Einstufung dieser Behandlungsverfahren ist aber noch nicht möglich.
    Fuß & Sprunggelenk 01/2006; 4(3-4):174-183. DOI:10.1007/s10302-006-0237-x
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Subclinical ovulatory disturbances (anovulation or short luteal phases within normal-length menstrual cycles) indicate lower progesterone-to-estrogen levels. Given that progesterone plays a bone formation role, subclinical ovulatory disturbances may be associated with bone loss or less than expected bone gain. Our purpose was to perform a meta-analysis of prospective studies in healthy premenopausal women to determine the overall relationship of subclinical ovulatory disturbances to change in bone mineral density. Two reviewers independently identified from serial literature searches 6 studies meeting inclusion criteria: a 2-year study in 114 young adult women, 2006-2009, Vancouver, Canada; a 2-year study in 189 premenopausal women, 2000-2005, Toronto, Canada; a single-cycle study in 14 young women, 1996-1997, Melbourne, Australia; an 18-month study in 53 women, 1990-1995, Santa Clara, California; a 4-year study in 27 women, 1988-1995, Vancouver, Canada; and a 1-year study in 66 women, 1985-1988, Vancouver, Canada. This meta-analysis included a combined sample size of 473 observations in 436 premenopausal women studied over 1-4 years and aged 14-47 years. The percentage of women with ovulatory disturbances varied significantly from 13% to 82%. Women with more frequent ovulatory disturbances had more negative percentage changes in spine bone mineral density (weighted mean difference = -0.86; P = 0.040) for random-effects analysis. There was significant heterogeneity among these 6 studies (I(2) = 80%). In summary, these data show that regularly menstruating women with more frequent ovulatory disturbances experience more negative changes in bone (approximately -0.9% per year). These cycles with silent estrogen/progesterone imbalance may be clinically important.
    Epidemiologic Reviews 11/2013; DOI:10.1093/epirev/mxt012 · 7.33 Impact Factor
  • Source

Preview

Download
1 Download