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Premenopausal osteoporosis

Did you know that eight out of every 10 cases of osteoporosis occur in women? While a woman's risk of developing osteoporosis increases with age, and menopause is a key risk factor for osteoporosis, premenopausal osteoporosis or bone loss that happens before menopause is not uncommon and can result in painful, debilitating fractures.

What is premenopausal osteoporosis?

Osteoporosis refers to the thinning of your bones or to a decrease in the density of your bone. As your bones become thinner, they fracture or break more easily. For millions of older adults, mostly women, such daily activities as standing, walking, and bending may be enough to cause a broken bone.

Premenopausal osteoporosis, or osteoporosis that occurs before menopause, is a real risk for many women. One American study of college and university age women found that 2% already had osteoporosis. Another 15% had significant loss in bone density. This condition is called osteopenia or early bone loss.

If fractures only happened to fingers or toes, this would be inconvenient but not limiting. Instead, osteoporosis and fractures predominantly affect the weight bearing bones that allow us to be active, the bones of the spine, the wrist, the shoulder and the hips. These fractures cause severe limitation and can also cause deformities, especially when they affect the spine.

What are the signs of premenopausal osteoporosis?

Premenopausal osteoporosis can be present even though there are no signs or symptoms. How fast someone loses bone depends on her specific risk factors. One woman might be in her 40s or 50s and have very strong bones with no indication of osteoporosis. Another woman can be in her 30s and have early signs of premenopausal osteoporosis, including fractures.

Why do thinner bones lead to painful fractures?

With osteoporosis, your bones eventually become thin enough that they break or fracture from seemingly minor causes. You might, for example, trip over a crack in the pavement and fracture your ankle. Or lifting a bag of compost might cause a wrist fracture.

If the decline in bone continues over a period of 10 to 20 years, bones continue to become weaker, thinner, and easier to break. While the first fracture will usually heal, as long as the bones are thin and weak, they will be susceptible to more fractures. With more fractures, your pain will escalate. Also, deformities in your spine (called a Dowager's hump) and other areas of your body may become more obvious.

You may have more difficulty getting around and doing daily activities because of the pain and stiffness. And more fractures could eventually lead to disability, immobility and even death.

Which women are at risk of premenopausal osteoporosis?

Important risk factors for premenopausal osteoporosis include:

  • A family history of osteoporosis and/or fractures
  • A history of eating disorders such as anorexia or bulimia
  • A history of other diseases, including kidney disease, coeliac disease, thyroid disease, and connective tissue disorders
  • A temporary loss of monthly periods for more than 12 months (except during pregnancy)
  • Long-term lack of exercise or overtraining
  • Long-term smoking
  • Low calcium intake
  • Use of certain drugs, including steroids, anticonvulsants, some cancer chemotherapies and long-term use of the blood thinner heparin.
  • Low weight

While you can control some risk factors, some you can't change. For example, you can't change your family history. Or you may develop cancer and need chemotherapy, even if it does raise your risk of premenopausal osteoporosis.

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