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®). 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.

Минеральная Плотность Костной Ткани У Молодых Женщин С Ювенильным Идиопатическим Артритом

“…Остеопороз за Z-показником < -2 SD у молодих жінок виявлено на рівні ПВХ у 12/30 (40 %) хворих, на рівні ШСК -у 7/29 (24 %), ВС -в 11/31 (35,5 %) та УВКП -у 9/17 (52,9 %) хворих. У 2012 році роз-роблено нові рекомендації [7] щодо діагностики ос-теопорозу на рівні хребта та ШСК у молодих осіб із захворюваннями, що впливають на кістковий мета-болізм. Згідно з цими рекомендаціями, у таких хво-рих рекомендовано оцінювати наявність остеопорозу за показником Т < -2,5 подібно до жінок в менопа-узальному періоді та чоловіків віком понад 50 років.…”

MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus

“…But it is not clear who should undergo a BMD test among T1DM patients. In young adults, diagnosis of osteoporosis rely not only on aBMD (T-score and not Z-score) but also on multiple fragility fractures (115). Early onset of T1DM can negatively affect bone size and mass.…”

Мінеральна Щільність Кісткової Тканини, Показники T Та Z У Молодих Чоловіків З Ювенільним Ідіопатичним Артритом

“…BMD's decrease to a level of osteopenia (Z-score below -2 SD) was found in 5 (20 %) patients at L 1 -L 4 , in 2 (8 %) patients at femoral neck, in 3 (12 %) patients at total body and in 2 (8 %) patients at ultradistal radius. According to the study made in 2012, osteoporosis of spine and femoral neck is diagnosed in young people with diseases that affect the bone tissue metabolism when T is < -2.5 SD, similar to postmenopausal women and men older than 50 years [6]. In our study, osteoporosis according to T-score was detected in 4 (16 %) patients at lumbar spine (L 1 -L 4 ), in 4 (16 %) patients at the level of femoral neck, 6 (24 %) patients at the level of total body and 2 (8 %) patients at ultra distal radius.…”

“…Diagnosis and treatment of OP in young people aged 20-45 years remain insufficiently studied. There are difficulties in the differentiation of young healthy people with low bone density that reflects low peak bone mass due to their mass and height, puberty period, hereditary factors and environmental impact during growth [4][5][6]. Differential diagnosis may be complicated by the fact that 30 % of young women and 50 % of young men usually have had traumatic fractures in childhood and adolescence [7][8][9][10][11].…”