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Osteoporosis in young adults: pathophysiology, diagnosis, and management

Abstract

Postmenopausal osteoporosis is mainly caused by increased bone remodeling resulting from estrogen deficiency. Indications for treatment are based on low areal bone mineral density (aBMD, T-score </= -2.5), typical fragility fractures (spine or hip), and more recently, an elevated 10-year fracture probability (by FRAX(R)). In contrast, there is no clear definition of osteoporosis nor intervention thresholds in younger individuals. Low aBMD in a young adult may reflect a physiologically low peak bone mass, such as in lean but otherwise healthy persons, whereas fractures commonly occur with high-impact trauma, i.e., without bone fragility. Furthermore, low aBMD associated with vitamin D deficiency may be highly prevalent in some regions of the world. Nevertheless, true osteoporosis in the young can occur, which we define as a T-score below -2.5 at spine or hip in association with a chronic disease known to affect bone metabolism. In the absence of secondary causes, the presence of fragility fractures, such as in vertebrae, may point towards genetic or idiopathic osteoporosis. In turn, treatment of the underlying condition may improve bone mass as well. In rare cases, a bone-specific treatment may be indicated, although evidence is scarce for a true benefit on fracture risk. The International Osteoporosis Foundation (IOF) convened a working group to review pathophysiology, diagnosis, and management of osteoporosis in the young, excluding children and adolescents, and provide a screening strategy including laboratory exams for a systematic approach of this condition.

Type Journal
Authors Ferrari, S.; Bianchi, M. L.; Eisman, J. A.; Foldes, A. J.; Adami, S.; Wahl, D. A.; Stepan, J. J.; de Vernejoul, M. C.; Kaufman, J. M.;
Publisher Name OSTEOPOROSIS INTERNATIONAL
Published Date 2012-10-01
Published Volume 23
Published Issue 12
Published Pages 2735-2748
Status Published in-print
DOI 10.1007/s00198-012-2030-x
URL link to publisher's version http://www.ncbi.nlm.nih.gov/pubmed/22684497
OpenAccess link to author's accepted manuscript version https://publications.gimr.garvan.org.au/open-access/11426