This narrative review discusses several aspects of the management of
osteoporosis in patients under 50 years of age. Peak bone mass is genetically determined but can also be affected by lifestyle factors. Puberty constitutes a vulnerable period. Idiopathic
osteoporosis is a rare, heterogeneous condition in young adults due in part to decreased osteoblast function and deficient bone acquisition. There are no evidence-based treatment recommendations. Drugs use can be proposed to elderly patients at very high risk. Diagnosis and management of
osteoporosis in the young can be challenging, in particular in the absence of a manifest secondary cause. Young adults with
low bone mineral density (BMD) do not necessarily have
osteoporosis and it is important to avoid unnecessary treatment. A determination of BMD is recommended for premenopausal women who have had a fragility fracture or who have secondary causes of
osteoporosis: secondary causes of excessive bone loss need to be excluded and treatment should be targeted. Adequate
calcium,
vitamin D, and a healthy lifestyle should be recommended. In the absence of fractures,
conservative management is generally sufficient, but in rare cases, such as
chemotherapy-induced
osteoporosis, antiresorptive medication can be used.
Osteoporosis in young men is most often of secondary origin and
hypogonadism is a major cause;
testosterone replacement
therapy will improve BMD in these patients. Diabetes is characterized by major alterations in bone quality, implying that medical
therapy should be started sooner than for other causes of
osteoporosis.
Primary hyperparathyroidism,
hyperthyroidism,
Cushing's syndrome and
growth hormone deficiency or excess affect cortical bone more often than trabecular bone.