How to manage osteoporosis before the age of 50

[en] This narrative review discusses several aspects of the management of osteoporosis in patients under 50 years of age. Peak bone mass is genetically determined but can also be affected by lifestyle factors. Puberty constitutes a vulnerable period. Idiopathic osteoporosis is a rare, heterogeneous condition in young adults due in part to decreased osteoblast function and deficient bone acquisition. There are no evidence-based treatment recommendations. Drugs use can be proposed to elderly patients at very high risk. Diagnosis and management of osteoporosis in the young can be challenging, in particular in the absence of a manifest secondary cause. Young adults with low bone mineral density (BMD) do not necessarily have osteoporosis and it is important to avoid unnecessary treatment. A determination of BMD is recommended for premenopausal women who have had a fragility fracture or who have secondary causes of osteoporosis: secondary causes of excessive bone loss need to be excluded and treatment should be targeted. Adequate calcium, vitamin D, and a healthy lifestyle should be recommended. In the absence of fractures, conservative management is generally sufficient, but in rare cases, such as chemotherapy-induced osteoporosis, antiresorptive medication can be used. Osteoporosis in young men is most often of secondary origin and hypogonadism is a major cause; testosterone replacement therapy will improve BMD in these patients. Diabetes is characterized by major alterations in bone quality, implying that medical therapy should be started sooner than for other causes of osteoporosis. Primary hyperparathyroidism, hyperthyroidism, Cushing's syndrome and growth hormone deficiency or excess affect cortical bone more often than trabecular bone. © 2020 The Authors

Disciplines :

Public health, health care sciences & services
Geriatrics

Author, co-author :

Rozenberg, S.; Department of Gynaecology-Obstetrics, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium

Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé

Bergmann, P.; Honorary Consulent, Nuclear Medicine CHU Brugmann CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale

Gielen, E.; Gerontology & Geriatrics, Department of Public Health and Primary Care, KU Leuven & Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium

Goemaere, S.; Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium

Kaufman, J. M.; Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium

Lapauw, B.; Department of Endocrinology Ghent University Hospital, Ghent, Belgium

Laurent, M. R.; Centre for Metabolic Bone Diseases, University Hospitals Leuven, Imelda Hospital, Bonheiden, Belgium

De Schepper, J.; Department of Pediatrics, UZ Brussel, Brussels, Belgium, Belgium

Body, J. J.; Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

Title :

How to manage osteoporosis before the age of 50

Publication date :

2020

Journal title :

Maturitas

ISSN :

0378-5122

eISSN :

1873-4111

Publisher :

Elsevier Ireland Ltd

Volume :

138

Pages :

14-25

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 13 August 2020

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