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Osteoporosis isn't just a disease of older women. It sometimes strikes women before the age of 40. But there are ways to prevent it.

Younger women usually don't have to worry about osteoporosis. One of the standards for measuring bone health, the T score, compares a patient's bone mineral density to the bone mineral density of a healthy 30-year-old woman. (In the United States, the T score may be computed against data for a healthy 30-year-old of the same sex and ethnicity.) But just because osteoporosis in younger women is rare, that doesn't it mean it never happens at all.

Causes of secondary osteoporosis in younger women

When osteoporosis occurs in women who have not yet reached menopause, and who aren't going through perimenopause, the first few years of the transition, it is usually secondary osteoporosis, the result of another disease process or using a medication that causes loss of bone mineral density. Some of the conditions that can cause osteoporosis in younger women include:

  • Anorexia nervosa
  • Celiac disease and other conditions that cause malabsorption of nutrients
  • Cushing's syndrome
  • Diabetes
  • Homocystinuria
  • Hyperparathyroidism
  • Hyperthyroidism
  • Juvenile arthritis
  • Kidney disease
  • Osteogenesis imperfecta

Sometimes the problem is a medication, such as:

  • Asthma medications. Osteoporosis has shown up in younger women who use beclomethasone dipropionate (Qvar), budesonide (Pulmicort), budesonide/formoterol (Symbicort), fluticasone (Flovent), fluticasone inhalable powder (Arnuity Ellipta), fluticasone/salmeterol (Advair), mometasone (Asmanex), and mometasone/formoterol (Dulera).
  • Depo-Provera (medroxyprogesterone acetate or MPA), for birth control.
  • Juvenile arthritis medications.In this category it is the glucocorticoid medications that are the main problem. These drugs include betamethasone, dexamethasone (Decadron), dexamethasone (Dexpak Taperpak, Decadron, Hexadrol), hydrocortisone (Cortef, A-Hydrocort), methylprednisolone (Depo-Medrol, Medrol, Methacort, Depopred, Predacorten), prednisolone, prednisone (Deltasone, Sterapred, Liquid Pred), and triamcinolone.
  • The seizure medication valproic acid (Depakote, Depakene).
  • Selective estrogen receptor modulators (SERMs) such as raloxifene and tamoxifene cause bone mineral loss when they are given to women who are still menstruating.
  • SSRI antidepressants. There are antidepressants that don't carry any risk of triggering osteoporosis, but the most commonly prescribed selective serotonin receptor inhibitors do. These medications include Citalopram (Celexa, Cipramil), escitalopram (Lexapro, Cipralex), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox, Faverin), paroxetine (Paxil, Seroxat), and sertraline (Zoloft, Lustral).
You have to work with your doctor to prevent secondary osteoporosis. Simply knowing that secondary osteoporosis is a possibility helps women ask the right questions of their doctors in a timely way. But there are other instances in which osteoporosis is a problem in younger women because of lifestyle choices. These situations are becoming increasingly common.

Lifestyle choices that build healthy bones

The (US) National Osteoporosis Foundation estimates that lifestyle choices account for 20 to 40 percent of the differences in bone mass between women who develop healthy bones and women who don't. Here are some problem areas for girls and young women and what to do about them.

  • Calcium intake. It's just not possible for girls to build healthy bones without calcium. When dairy products are not consumed, for whatever reason, a calcium supplement is a useful backup supply. Any girl over the age of four needs at least 1,000 to 1,300 mg of calcium per day from food and supplements. 
  • Magnesium intake. It's also not possible for girls to build healthy bones without magnesium. Bones can't absorb calcium when magnesium levels are too low. The best way to get magnesium is to eat some kind of leafy green every day. Some children's supplements contain magnesium.
  • Physical exercise. The bone building process is triggered by changes in physical activity. This means that both adequate rest and a variety of physical activities are important for building healthy bone. The higher the impact, the more bone is built. This means that easy and slow repetitive exercises like cycling and rowing don't build bone as well as hitting a ball, jumping up from the ground (jump rope or tumbling or basketball) or snatching a heavy weight. Power moves activate the bone recycling and bone rebuilding process. Repetitive, easy, slow moves disable it.
  • Use of the pill. Very-low dose estrogen contraceptives have been associated with bone mineral loss in teens. Ask your doctor what is best for you.
  • Sunlight deprivation. Girls who don't get exposure to sun don't get the natural vitamin D they need to build strong bones that will last them the rest of their lives. When girls don't get sun, they need supplemental vitamin D. The traditional remedy for this problem in northern Europe was cod liver oil, but in most of the world, vitamin supplement capsules will work. Both vitamin D2  (ergocalciferol)  and vitamin D3 (cholecalciferol) are effective, except D3 is better for girls and women who have kidney disease. Girls and women who live in northerly climates need supplements during the winter, but it's best to start D supplements in late summer to build up reserves of the vitamin. Taking 1,000 IU of D3 daily is better than taking large (5,000 to 50,000 IU) doses of D2.
It isn't always possible to avoid premature osteoporosis, but working with your doctor to prevent secondary osteoporosis and making healthy lifestyle choices will help. It is particularly important to be physically active early in life, and to make sure you get enough calcium, magnesium, and vitamin D for a lifetime of healthy bones.

  • Abraham A, Cohen A, Shane E. Premenopausal bone health: osteoporosis in premenopausal women. Clin Obstet Gynecol. 2013 Dec.56(4):722-9. doi: 10.1097/GRF.0b013e3182a8ae55. Review. PMID: 24022503.
  • Cohen A. Premenopausal Osteoporosis.Endocrinol Metab Clin North Am. 2017 Mar.46(1):117-133. doi: 10.1016/j.ecl.2016.09.007. Epub 2016 Nov 24. Review. PMID: 28131128 .
  • Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O'Karma M, Wallace TC, Zemel BS. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. 2016 Apr.27(4):1281-1386. doi: 10.1007/s00198-015-3440-3. Epub 2016 Feb 8. Review. Erratum in: Osteoporos Int. 2016 Apr
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  • Photo courtesy of SteadyHealth

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