Weight-bearing exercise, vitamin D, calcium: few data on tx of low BMD before menopause.(Gynecology)

MIAMI -- Management of low bone density in premenopausal women is a tightrope walk with a short stick. There hasn't been enough research to help physicians find the right balance between overtreatment and undertreatment.

"We are all confused about what to do about bone density in premenopausal women," Dr. E. Michael Lewiecki said at the annual meeting of the International Society for Clinical Densitometry (ISCD).

Osteoporosis guidelines from the World Health Organization address only postmenopausal women and cannot be extrapolated for those who are premenopausal. At the same time, it's clear that premenopausal women who have a maternal history of hip fracture, a previous low trauma fracture, or a history of long-term corticosteroid therapy are at higher risk of having or of developing osteoporosis, according to recently established ISCD criteria, which are in press at the Journal of Clinical Densitometry.

Peak bone mass reaches its maximal mineral mass around aged 20, when the skeleton is fully mature. Genetics can account for as much as 60%-70% of variability in peak bone mass, and environmental factors, such as calcium deficiency, for the remainder. If peak bone mass is not attained during childhood and adolescence, a woman enters adulthood with less bone. Then "when you are postmenopausal, you lose bone from a lower starting point," said Dr. Lewiecki, osteoporosis director at New Mexico Clinical Research and Osteoporosis Center, Albuquerque.

Research on bone loss in premenopausal women is limited and sometimes contradictory. Most studies have been small, cross sectional, and not well controlled for differences in ethnicity, weight, lifestyle, definition of menopause, or skeletal site measured. Nor are ...