Osteoporosis in young adults: pathophysiology, diagnosis, and management
| Autor: | Ferrari, S, Bianchi, Ml, Eisman, Ja, Foldes, Aj, Adami, Silvano, Wahl, Da, Stepan, Jj, de Vernejoul MC, Kaufman, Jm, For the IOF Committee of Scientific Advisors Working Group on Osteoporosis Pathophysiology |
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| Rok vydání: | 2012 |
| Předmět: |
young adults
Peak bone mass musculoskeletal diseases medicine.medical_specialty Pediatrics Adolescent Endocrinology Diabetes and Metabolism Osteoporosis vitamin D deficiency Bone remodeling Young Adult Bone Density Pregnancy Internal medicine medicine Humans Genetic Predisposition to Disease Young adult Bone mineral osteoporosis business.industry medicine.disease Rheumatology Pregnancy Complications Physical therapy Female Secondary osteoporosis business Osteoporotic Fractures |
| Zdroj: | Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 23(12) |
| ISSN: | 1433-2965 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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