We tend to think of osteoporosis as a disease of old age. And in most cases, it is. Osteoporosis, a condition in which bone mass diminishes and fractures become more likely, is most common in postmenopausal women. However, certain factors can put younger women at risk for this largely invisible disease.
Some medical conditions and medications can contribute to osteoporosis risk in premenopausal women. Dr. Carolyn Jachna, an internal medicine physician specializing in bone and mineral diseases at Washington University Physicians, says they include autoimmune disorders, such as lupus and rheumatoid arthritis, hyperthyroidism, diabetes, eating disorders and digestive disorders that affect absorption of calcium and vitamin D, such as celiac disease or inflammatory bowel disease.
Medications that increase the risk of osteoporosis include oral or high-dose inhaled steroids that are used continually over time, the injectable contraceptive depo-provera, excessive thyroid hormone used to treat hypothyroidism and some anti-seizure medications, such as dilantin.
“Some of the other things that people may be using on a regular basis are over-the-counter antacids that contain aluminum, or medicines for GERD, such as Nexium, Prevacid and Prilosec,” says Dr. Cynthia Byler, a physician at Orthopedic Associates. “I’m certainly not telling people not to take their medicines, but there are some things out there that are fairly commonly taken by people because they need to, yet there are certain disadvantages to taking those medications, as well.”
Women who are thin and smallboned or have exercised to the point of amenorrhea, in which normal menstrual cycles cease, also may lose bone density prior to menopause. And above all, “smoking is a bad, bad thing for your bones,” Byler says. “It’s bad for the bone cells that are producing new, healthy bone. It inhibits their ability to lay down new bone.”
If premenopausal women have these risk factors, bone density testing may be recommended, Jachna says. “We determine this on a case-by-case basis—there really are no universal guidelines.”
In most cases, premenopausal women who have risk factors for osteoporosis are counseled by their physicians to take preventive steps. “First, we work on making sure the woman has adequate calcium and vitamin D levels,” Jachna says. Levels may be checked and dietary changes made as needed so that premenopausal women consume the National Institutes of Health’s recommended amounts of at least 1,000 mg of calcium and 600 IU of vitamin D daily through diet and supplementation.
Another important preventive action is regular weight-bearing exercise, such as walking, climbing stairs or lifting weights. “And of course we focus on controlling the medical condition that may be contributing to bone disease,” Jachna adds. “The more we can control the condition without medications, like steroids, that can contribute to bone loss, the better.”
Women who are concerned about their bone health can take a quick online checkup designed by the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. The online tool, which assesses bone health based on a short questionnaire, can be found by searching for ‘bone checkup tool.’