HARROGATE, ENGLAND — Targeted use of bone densitometry in premenopausal women can identify a significant number of patients who would benefit from bone protection, a study has shown.
Of 301 premenopausal women referred to London's Queen Elizabeth Hospital during a 4-year period for dual-energy x-ray absorptiometry (DXA) because of possible increased risk of osteoporosis, 41% had abnormal scans, reported Elizabeth Koshy, M.D., in a presentation at the annual conference of the National Osteoporosis Society.
Premature menopause accounted for 43 (14%) of the patients referred for DXA. Of these, 37% had abnormal scans. Steroid use accounted for 19% of the referrals, of which 47% of the scans were abnormal. Of the approximately 14% of referrals based on family history, 27% resulted in abnormal scans. Osteopenia or previous fracture was the primary or coexisting indication for 37 or 12% of the patients; among these, 54% were abnormal. Amenorrhea was the impetus for 11 (3.7%) of the scans, and 64% of these were abnormal, reported Dr. Koshy of Imperial College London. The medical conditions associated with the highest proportion of abnormal scans were anorexia nervosa (57%) and inflammatory bowel disease (52%).
A logistic regression analysis identified low calcium/vitamin D intake, a body mass index of less than 20 kg/m2, and amenorrhea as significant risk factors associated with a lower bone mineral density. Such findings, Dr. Koshy said, suggest that “focused use of bone densitometry in women younger than 50 with any of these risk factors can help to identify patients with future fracture risk who may merit osteoporosis prevention.”
In most premenopausal women, it may be that the best treatment option remains supplementation with calcium and vitamin D. However, “selective DXA does seem to identify a significant number who could benefit from additional intervention,” she said.
Much attention in recent years has been focused on the importance of routine bone density testing for postmenopausal women, but the findings of this study add weight to the argument that younger women who have significant risk factors should be tested as well, “ideally at peak bone mass [between ages 21 and 35],” Dr. Koshy said.