New review outlines screening strategies for osteoporosis in young adults
June 19, 2012 in Diseases, Conditions, Syndromes
Much of the research defining osteoporosis and fracture risk has focused on older adults, i.e. postmenopausal women and men over the age of 50. While older adults are at highest risk of osteoporosis and related fractures, the disease can also affect younger adults between 20 and 50 years of age. However, the diagnosis and management of osteoporosis in young adults is complicated by special challenges, including a complex pathophysiology and the related fact that there is no clear definition of osteoporosis, or of intervention thresholds, in this age group.
An International Osteoporosis Foundation (IOF) scientific working group has now published a review which outlines the pathophysiology, diagnosis and management of osteoporosis in young adults, providing a clear screening strategy that includes the use of clinical and laboratory exams.
Dr. Serge Ferrari of the University of Geneva andchair of the IOF Working Group on Osteoporosis Pathophysiology, explains the diagnostic challenge faced by clinicians, "Low bone mass in this age group may not necessarily represent a pathological condition, but result instead from low peak bone mass in relation to body size, late puberty, or genetic and environmental background."
On the other hand, there are young adults who may truly have osteoporosis with bone fragility at a young age. This may result from altered bone modelling and/or remodelling during growth or later due to a chronic disorder or a genetic or idiopathic condition. Typical examples would be inflammatory bowel diseases, particularly Crohn's disease. These diseases impair bone mass gain and/or accelerate bone loss because of malabsorption and poor nutrient intake. In addition, low levels of physical activity, secondary amenorrhea, and in many cases the effects of corticosteroid treatment, can have an impact on bone mass.
Distinguishing between these two situations can be all the more difficult because up to 30% of young women and 50% of young men have had fractures during childhood and adolescence, usually traumatic. These are not necessarily associated with skeletal fragility.
An apparently low areal bone mineral density (T-score < -2.5 at spine or hip by DXA) must be interpreted with caution in young adults of small body size (constitutionally lean) and/or stunted growth. Inaccurate 'diagnosis' of osteoporosis in young subjects can lead to anxiety, unnecessary drug prescriptions, and in some countries potential restrictions of insurance coverage. Individuals with low bone mass, although possibly deserving investigation depending on the context (for instance to rule out vitamin D deficiency) should not automatically be classified as osteoporotic. This diagnosis only applies when there is evidence of skeletal fragility.
Nevertheless, a truly low BMD and/or unusual fractures (such as low-trauma, multiple and vertebral) should prompt investigation for secondary causes of osteoporosis. Careful medical history, clinical and laboratory investigations can reveal an underlying disease that requires specific medical intervention, which in turn will improve bone mass. Bisphosphonates may improve BMD in young subjects with osteoporosis due to various disorders, however the evidence is scarce so far and there are no data on their anti-fracture efficacy. In any case, the indications and duration of anti-resorptive treatment in the young should be as restrictive as possible, particularly in the absence of secondary causes, multiple and/or fragility (vertebral) fractures, and high bone turnover accompanied by documented bone loss.
Professor Cyrus Cooper, chair of the IOF Committee of Scientific Advisors, concluded, "This review will be of assistance to clinicians managing this important problem. The clinical relevance of low bone mineral density in young adults is less well understood than is the case in postmenopausal women and older men. Furthermore, many treatment modalities licensed for use in postmenopausal osteoporosis have not been carefully evaluated in younger adults. Clear guidance as to the interpretation of BMD and the appropriate use of treatments is therefore most timely."
More information: Osteoporosis in young adults: pathophysiology, diagnosis and management. Osteoporosis International 2012, DOI: 10.1007/s00198-012-2030-x
Journal reference:
Osteoporosis International
Provided by
International Osteoporosis Foundation
-
Experts recommend men at risk for osteoporosis undergo bone density testing
Jun 18, 2012 |
not rated yet |
0
-
Older women with normal T-scores may not need bone mineral density screening for 15 years
Jan 18, 2012 |
not rated yet |
0
-
Grandpa's broken hip may mean weaker bones for his grandsons
Jan 29, 2010 |
not rated yet |
0
-
New study highlights what works in osteoporosis treatment
Jul 11, 2011 |
not rated yet |
0
-
IOF and ECTS issue guidance on management of glucocorticoid-induced osteoporosis
Mar 27, 2012 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011
- More from Physics Forums - Independent Research
More news stories
FDA warns of infections tied to Tennessee pharmacy
(AP)—Government health officials are investigating several health problems reported with potentially contaminated medications made by a Tennessee specialty pharmacy.
Diseases, Conditions, Syndromes
16 hours ago |
not rated yet |
0
Comorbidities common with alopecia areata
(HealthDay)—Comorbid conditions often accompany alopecia areata, according to a study published online May 22 in JAMA Dermatology.
Diseases, Conditions, Syndromes
17 hours ago |
not rated yet |
0
Top-ranked golfer beats scoliosis
(HealthDay)—As a world-class golfer, Stacy Lewis' accomplishments are remarkable. But it was a physical challenge in her childhood that defined her ascent to the top of her sport.
Diseases, Conditions, Syndromes
18 hours ago |
not rated yet |
0
Saudi to send animal samples to US in coronavirus probe (Update)
Saudi Arabia said Friday it would send samples taken from animals possibly infected with a deadly SARS-like virus to the United States for testing in a bid to find the source of disease.
Diseases, Conditions, Syndromes
21 hours ago |
not rated yet |
0
WHO voices deep concern over spread of SARS-like virus
The World Health Organization voiced deep concern Thursday over the SARS-like virus that has killed 22 people in less than a year, saying it might potentially spread more widely between humans.
Diseases, Conditions, Syndromes
May 24, 2013 |
5 / 5 (1) |
0
Heart failure accelerates male 'menopause'
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
First drug to improve heart failure mortality in over a decade
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
Feds fight morning-after pill age ruling in NY
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
Death highest in heart failure patients admitted in January, on Friday, and overnight
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
Engineered cytomegalovirus protects monkeys from HIV equivalent
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
Researchers identify first drug targets in childhood genetic tumor disorder
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...