Premenopausal bone loss - a risk factor for osteoporosis

Article Abstract:

Low bone mass is an important health problem, particularly for postmenopausal women. Reduction of bone mass, which contributes to the likelihood of fractures, results from a combination of two factors. One factor is bone mineral loss, which is most significant after menopause. The other factor is peak bone mass, which is generally reached in the third or fourth decades of life. If the peak bone mass achieved at this time is low, the effects of osteoporosis will become severe earlier in life. Significant postmenopausal bone mineral loss will always occur, regardless of the peak bone mass. Nevertheless, it is important to take steps to ensure that women achieve adequate peak bone mass to forestall the effects of osteoporosis later in life. Adequate nutrition, particularly calcium intake, proper exercise, and genetic factors play an important role in determining peak bone mass. An article in the November 1, 1990 issue of The New England Journal of Medicine (NEJM) now adds to the growing body of information linking decreases in bone mass to menstrual abnormalities. It is well established that some elite women athletes, such as marathon runners, become amenorrheic (stop menstruating), and that these same women also suffer from decreasing bone mass, which may become critical in later years. However, not all elite women athletes become amenorrheic, indicating that other factors must be at work. The new evidence indicates that among menstruating women, bone mineral loss is associated with menstrual abnormalities, particularly occasional anovulatory cycles. This association was found to be independent of the level of exercise of the subjects, whether marathon runners, casual runners, or more sedentary women. Osteoporosis is considered to be due to reduction in estrogen levels among postmenopausal women. It is not certain, however, why abnormal cycles contribute to bone mineral loss in premenopausal women. The authors of the NEJM article suggest that decreased progesterone might be implicated. However, solid evidence is not yet available. Considering the effect that bone mineral loss is likely to have upon health in later years, it is critical that the factors which contribute to bone mineral loss in younger women, and the relation of these factors to abnormal cycles, be identified. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Women, Complications and side effects, Risk factors, Physiological aspects, Running, Women's fitness, Osteoporosis, Menstrual cycle, Marathon running, Menstruation disorders, editorial

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Calcium supplementation and increases in bone mineral density in children

Article Abstract:

Calcium supplementation may increase bone density in prepubertal children whose dietary calcium is close to the recommended dietary allowance. Of 45 pairs of identical twins between six and 14 years old, one twin received 1,000 milligrams (mg) of calcium citrate malate per day, and the other received a placebo, an inactive substance, over a three-year period. The average daily intake of calcium was 1,612 mg for twins given a calcium supplement, and 908 mg for those given a placebo. Among 22 pairs of twins who had not reached puberty, the twin given a supplement had a significantly larger increase in bone mineral density in the lower and distal radius (lower arm) and lumbar spine, compared with the twin given a placebo. Among 23 pairs of twins who entered puberty during the study or who were post-pubertal, the twin given a supplement did not have higher bone mineral density than the twin given a placebo.

Bones, Children, Growth, Calcium (Nutrient), Calcium, Dietary, Bone densitometry, Bone development

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A 56-year-old woman with virilization

Article Abstract:

A 56-year-old woman was referred to Massachusetts General Hospital seven years after menopause because she had developed male-pattern baldness and excessive hair on her face and body (hirsutism). Her testosterone level was much higher than normal for a woman her age. On an ultrasound scan, both ovaries appeared cystic. She was treated with a hysterectomy and her ovaries were also removed. On examination, the ovaries were a normal size and were not cystic. However, the ovarian stroma was enlarged, and was probably responsible for the increased testosterone production. Three months after her hysterectomy, her testosterone levels had dropped to normal and her male-pattern baldness and hair distribution were regressing.

Case studies, Diseases, Ovaries, Virilism

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