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Epidemiology and etiology of premenopausal osteoporosis

Carolyn B Becker, MD
Adi Cohen, MD, MHS
Section Editor
Clifford J Rosen, MD
Deputy Editor
Jean E Mulder, MD


Osteoporosis is a skeletal condition characterized by low bone mass, which is associated with reduced bone strength and an increased risk of fractures. Osteoporosis occurs most commonly in postmenopausal women. Numerous guidelines and recommendations exist regarding the evaluation and management of osteoporosis in this population. Male osteoporosis has also gained attention as a growing public health concern. Postmenopausal osteoporosis and osteoporosis in men are reviewed separately. (See "Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women" and "Overview of the management of osteoporosis in postmenopausal women" and "Epidemiology and etiology of osteoporosis in men".)

Both fractures and low bone mass are less common in premenopausal women. Low bone mass, when present, may be related to either inadequate peak bone mass acquisition and/or ongoing bone loss. Bone loss and/or fractures can often be attributed to a secondary cause such as estrogen deficiency, glucocorticoid exposure, or hyperparathyroidism. The term idiopathic osteoporosis is reserved for the subset of women with no apparent etiology or known secondary cause.

The diagnosis of osteoporosis and guidelines for treatment of osteoporosis based upon bone mass in postmenopausal women do not generally apply to premenopausal women as the relationship between bone mass and fracture in premenopausal women is not the same as in postmenopausal women.

This topic reviews the definition, epidemiology, and etiology of premenopausal osteoporosis. Evaluation and management will be reviewed separately. (See "Evaluation and treatment of premenopausal osteoporosis".)


Low bone mass — The measurement of bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is used as an index of bone strength and fracture risk, and can be used to diagnose osteoporosis in some populations, such as postmenopausal women. The World Health Organization (WHO) defines osteoporosis in postmenopausal women as a BMD value at the spine, hip, or forearm of 2.5 or more standard deviations (SD) below the young adult mean (T-score ≤-2.5), with or without the presence of a fragility fracture [1]. (See "Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women" and "Overview of dual-energy x-ray absorptiometry".)

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Literature review current through: Nov 2017. | This topic last updated: Mar 07, 2017.
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