Bone Density in Premenopausal Women

Mazess and Barden studied 300 young women between the ages of 20 and 40 (7). BMD was measured in the PA spine and proximal femur using DPA and at the ultradistal and 33% radial sites using SPA. BMD did not change significantly with age at any site. BMD tended to decrease with age at the femoral neck and Ward's area, but the change was not statistically significant. Additional BMD measurements were obtained at the spine and midradius after 2 years (8). In this longitudinal extension of the original study, there was no evidence of age-related bone loss at either the spine or 33% radial site.

Hansen (9) evaluated 249 healthy premenopausal women whose average age was 39 years, measuring BMD at the distal forearm using SPA and at the PA spine and proximal femur using DXA (Hologic QDR-1000). In this study, no decline in BMD was seen at any site after age 30 and peak BMD appeared to be reached prior to age 30.

Two other large cross-sectional studies have suggested that BMD in the proximal femur does decline in women prior to menopause. Rodin et al. (10) found a significant premenopausal decline in femoral neck BMD in a study of225 women who ranged in age from 18 to 52. Similarly, Bonnick et al. (11) found a decline in proximal femoral BMD after the age of 30 in a study of 237 premenopausal women ages 20 to 45. In this latter study, no increase in BMD in the spine or proximal femur was seen in any age group, suggesting that peak BMD in both regions was achieved prior to the age of 20. There was no significant change in spine BMD, again suggesting that spine BMD does not change.

Hui et al. (12) measured bone density in 130 healthy premenopausal women at the PA lumbar spine and proximal femur with DXA (Hologic QDR 1000W) on three occasions each over a 1- to 9-year period. The average age of the women at the start of the study was 40.4 years and the average follow-up was 3.9 years. In the PA lumbar spine, BMC, bone area, and BMD all increased during the study. The L2-L4 BMD increased at a rate of 0.00209 g/cm2 per year. In contrast, total hip BMC, bone area, and BMD did not change significantly during the study. At the femoral neck, however, a significant decline in BMD was noted, which was the result of a decline in BMC and an increase in area. The rate of decline in BMD at the femoral neck was -0.00357 g/cm2 per year. The authors found that greater losses of BMD at the femoral neck were associated with weight loss and lower levels of estrogen.

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