Endocrine Abstracts

Introduction: Premenopausal women that suffer from osteoporosis are under-diagnosed and many anti-osteoporotic medications are neither licensed for young women, nor have they been established as safe or effective. Current guidelines on osteoporosis only address postmenopausal women, resulting in uncertainty and insufficient treatment for premenopausal women. To prevent bone fragility in young women, more knowledge and education about possible risk factors for osteoporosis in young age is needed.

Methods: Women under the age of 50 were recruited to fill out a questionnaire, if their T-values were osteoporotic, or if they presented with one or more fractures with a T-value of -2,0. They answered 42 questions on potential risk factors for bone fragility. Frequencies of risk factors were compared with published prevalences for the normal premenopausal population.

Results: Data of 104 women was analysed. The average age at first diagnosis of osteoporosis/osteopenia was 37 years (range: 19-49), 78% had already sustained a fracture. 40% had been pregnant at least once, but only 74% of them had given birth. 16% of the patients had involuntary infertility, of these 82% had never been pregnant. Female infertility is estimated to affect 7,5% in the general population. 75% of the women had used or were on hormonal contraception, which is less than in the German population (87%). 14% had started hormonal contraception prior to 16 years of age. Hypermenorrhoea was more common amongst young osteoporosis patients than in the general female population (22% vs. 10%). Nearly half of the participants (45%) reported secondary amenorrhoea of more than 6 months at least once in their lifetime, much more than women without osteoporosis (1,5-3%). 22% of our patients stated having had an eating disorder for longer than one year. The lifetime prevalence for eating disorders in Germany ranges from 1,7-3,6% for anorexia nervosa and 2,6% for bulimia nervosa. 74% of the participants with an eating disorder also had amenorrhoea. Depression was more prevalent in young osteoporotic women (13%) than in the average population (8,2%), as was hypothyroidism (18% vs. 1-2%). 30% of the participants worked shifts or admitted to a chronic sleep disorder.

Discussion and conclusion: Compared to the normal population, some reproductive endocrine characteristics are more frequent in young women with osteoporosis, such as hyper- and amenorrhoea, eating disorders, hypothyroidism and depression.