Gourlay Margaret L, Brown Sue A
Department of Family Medicine, Robert Wood Johnson Clinical Scholars Program, University of North Carolina-Chapel Hill, 27599, USA.
Arch Intern Med. 2004 Mar 22;164(6):603-14. doi: 10.1001/archinte.164.6.603.
Osteoporosis can occur at any age. In premenopausal osteoporosis, full achievement of peak bone mass may be curtailed, and accelerated bone loss may occur in young adulthood. Premenopausal osteoporosis may be associated with chronic glucocorticoid therapy, prolonged amenorrhea, anorexia nervosa, rheumatoid arthritis, and diseases that affect calcium and vitamin D metabolism. Lesser degrees of bone loss may be associated with common conditions such as dieting, low calcium intake, smoking, and oligomenorrhea. Owing to a paucity of prospective studies on screening and treatment in younger age groups, few practice recommendations exist to guide the management of osteoporosis in young adults. We review the most important clinical concerns in premenopausal osteoporosis, including measurement of bone mass, normal bone accrual, risk factors for premature bone loss, clinical outcomes, and management issues. We emphasize clinically relevant information for primary care physicians, who are usually the first to encounter premenopausal patients with risk factors for early bone loss.
骨质疏松症可发生于任何年龄。在绝经前骨质疏松症中，峰值骨量的充分达成可能会受到限制，并且在成年早期可能会出现加速的骨质流失。绝经前骨质疏松症可能与长期糖皮质激素治疗、长期闭经、神经性厌食症、类风湿性关节炎以及影响钙和维生素D代谢的疾病有关。程度较轻的骨质流失可能与节食、钙摄入量低、吸烟和月经过少等常见情况有关。由于针对较年轻年龄组的筛查和治疗的前瞻性研究较少，几乎没有实践建议可用于指导年轻成年人骨质疏松症的管理。我们回顾了绝经前骨质疏松症中最重要的临床问题，包括骨量测量、正常骨累积、过早骨质流失的危险因素、临床结局和管理问题。我们强调对初级保健医生具有临床相关性的信息，他们通常是最先遇到有早期骨质流失危险因素的绝经前患者的人。
