Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, Upper Borough Walls, Bath BA1 1RL, UK.
Best Pract Res Clin Rheumatol. 2010 Jun;24(3):313-27. doi: 10.1016/j.berh.2010.01.006.
There is no agreed definition of osteoporosis in pre-menopausal women. The International Society for Clinical Densitometry recommends using Z-score, and women with Z-scores of -2.0 or lower should be defined as having a bone density that is 'below the expected range for age'. The diagnosis is more readily made in the presence of a low-trauma fracture. The relationship between low bone mineral density (BMD) in young pre-menopausal women and its associated fracture risk is not the same as in older women with a low BMD. Between 50% and 90% of pre-menopausal women will have an underlying secondary cause, the most common being eating disorders, anorexia nervosa and use of glucocorticoids. Management should focus on identifying the underlying cause and treating it where possible. The use of pharmacological therapy under other circumstances should be considered carefully. Women with only low BMD and no other risk factors probably require no pharmacological intervention. Those with low BMD and secondary causes or with a severely low BMD, or those who have fragility fractures, may require treatment with anti-resorptive agents, which can include oestrogen, bisphosphonates, calcitonin, calcitriol or anabolic therapy with teriparatide. Selective oestrogen receptor modulators (SERMs) should be avoided as they cause further bone loss in menstruating women. Alendronate and risedronate have been licensed for use in glucocorticoid-induced osteoporosis. These drugs accumulate in the human skeleton and have been shown to cross the placenta and accumulate in newborn rats. The effects on human pregnancy are unclear, although normal pregnancies have been reported. Pre-menopausal women with osteoporosis should be followed up until the BMD is stable, which can usually be ascertained by follow-up scans at 18-36-month intervals.
在绝经前女性中，骨质疏松症尚无公认的定义。国际临床密度测定学会建议使用 Z 评分，Z 评分低于-2.0 的女性应被定义为骨密度“低于年龄预期范围”。在存在低创伤性骨折的情况下，诊断更为容易。年轻绝经前女性的低骨密度（BMD）与其相关骨折风险之间的关系与低 BMD 的老年女性不同。50%至 90%的绝经前女性将存在潜在的继发性原因，最常见的是饮食失调、神经性厌食症和使用糖皮质激素。治疗应侧重于确定潜在原因，并在可能的情况下进行治疗。在其他情况下，应仔细考虑使用药物治疗。只有低 BMD 且无其他危险因素的女性可能不需要药物干预。那些 BMD 低且有继发性原因或 BMD 严重降低，或有脆性骨折的女性，可能需要使用抗吸收剂治疗，包括雌激素、双膦酸盐、降钙素、骨化三醇或特立帕肽的合成代谢治疗。应避免使用选择性雌激素受体调节剂（SERMs），因为它们会导致月经女性进一步骨质流失。阿仑膦酸盐和利塞膦酸盐已获准用于治疗糖皮质激素诱导的骨质疏松症。这些药物在人体骨骼中积累，并已证明可以穿过胎盘并在新生大鼠中积累。对人类妊娠的影响尚不清楚，尽管有报道称正常妊娠。患有骨质疏松症的绝经前女性应随访至 BMD 稳定，通常可以通过 18-36 个月间隔的随访扫描来确定。
