Osteoporosis Risk Assessment for Premenopausal Women

Am I premenopausal?

You are considered premenopausal if you are still having menstrual periods. During your perimenopausal years (around the time of menopause), your monthly periods may become irregular. You are still considered premenopausal until your periods have stopped for 12 months in a row without a medical reason.

Why should I care about risk assessment?

Osteoporosis is a silent disease that causes bones to become thin and weak, often resulting in broken bones. Once you know your personal risk factors for osteoporosis, you can take actions to control the many risks that can be changed. Your actions to reduce risk factors can help prevent osteoporosis later in life.

Who is at risk for osteoporosis?

Osteoporosis can happen to anyone – the disease has no age, gender or ethnic boundaries. Osteoporosis more commonly affects the elderly, postmenopausal women, and individuals of Caucasian or Asian decent. This does not mean that others are not at risk for osteoporosis. Men, African-Americans, and other populations get osteoporosis, too; they are just at a slightly lower risk than Caucasian or Asian postmenopausal women.

Am I at risk for osteoporosis?

You may be at risk for osteoporosis if you answer "yes" to many of the following risk factors. The more risk factors you check, the greater your risk for osteoporosis and related fractures to occur later in life.

Check if you ...

check box are Caucasian or Asian
check box weigh less than 127 lbs (low weight for height)
check box have any relatives who have/had osteoporosis (broken bone of the wrist, hip, leg or spine occurring without major trauma, a height loss of more than 1-1/2 inches or stooped back)
check box have a personal history of fractures (broken bones) during adulthood (without trauma, such as a car accident or severe sports injury)
check box have previous fractures of the spine or x-ray evidence of bone loss
check box have a temporary loss of monthly periods for more than 12 consecutive months or infrequent periods for several years (excluding pregnancy)
check box have any of the following chronic diseases/conditions often associated with osteoporosis:
  check box AIDS
  check box Chronic lung disease
  check box Diabetes, Type I
  check box Eating disorders (anorexia, bulimia)
  check box Hyperparathyroidism (excessive parathyroid hormone
  check box Hyperthyroidism (excessive thyroid hormone)
  check box Inflammatory bowel disease
  check box Kidney disease
  check box Liver disease
  check box Lupus
  check box Malabsorption (from celiac sprue or other gastrointestinal disorders)
  check box Neurological diseases (such as stroke and multiple sclerosis)
  check box Rheumatoid arthritis
check box have a history of bed rest or immobility for more than 6 months
check box are taking or have taken any of the following medications:*
  check box Blood thinning agents when necessary for chronic use (such as long-term use of Coumadin or Heparin)
  check box Chemotherapy
  check box Dilantin (Phenytoin), and some other drugs used to treat seizure disorder or depression
  check box Gonadotropin-releasing hormone analogues (Lupron and Zoladex) used to treat endometriosis
  check box Immunosuppressants (such as methotrexate or cyclosporin)
  check box Steroids (such as prednisone or cortisone) used for more than 3-6 months to treat asthma, arthritis or other diseases
  check box Thyroid medications, taken in high dosages, or lack of routine blood tests for TSH-level monitoring
check box have had a lifelong history of low calcium intake (few, if any, dairy products with no calcium supplements)
check box have a lifelong history of little exercise (less than 60 minutes per week)
check box have a history of long-term smoking (more than 1 pack a day for more than 5 years) or currently use tobacco products
check box consume alcohol to excess and/or have a history of alcohol abuse

Although risk factors may increase your likelihood of getting osteoporosis, having risk factors does not mean that you have or will get the disease. Be aware that there may be additional risk factors that have not yet been identified. Premenopausal women who do not have any of the above risk factors for osteoporosis may not be protected from developing the disease.

How can I promote healthy bones during my premenopausal years?

Knowledge of your personal risk factors for osteoporosis should encourage you to take actions to promote healthy bones and motivate you to discuss your concerns with your medical professional. You can make a lifelong commitment to prevent osteoporosis. See "Promoting Healthy Bones";.

Is Bone Mineral Density (BMD) Testing recommended for premenopausal women?

In general, BMD testing is not indicated for women before menopause. There are currently no medications approved for osteoporosis prevention or treatment in healthy premenopausal women. There are a few instances, however, in which BMD testing might be recommended in premenopausal women. Long-term use of steroids or glucocorticoids is the most common of these instances. The most common diseases requiring steroid treatment in young women are asthma, rheumatoid arthritis, lupus, inflammatory bowel disease and multiple sclerosis. In selected cases, medication for osteoporosis might be appropriate in these women. Alendronate (Fosamax) is approved for the treatment of osteoporosis caused by the use of steroid medications. Risedronate (Actonel) is approved for both the prevention and treatment of steroid-induced osteoporosis. See "FDA-Approved Medications for Osteoporosis Prevention and/or Treatment" (C-14). Other possible candidates who might warrant further evaluation of skeletal health include premenopausal women with diseases that affect menstrual function (such as anorexia nervosa) or premenopausal women with multiple fractures.

When you reach menopause and medication options for treatment are available, it is important to speak to your doctor about your risk of osteoporosis and possible need for BMD testing.

(c) Helen Hayes Hospital/NYS Department of Health - 11/03

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