Risk Assessment for Premenopausal Women

Am I premenopausal?

You are considered premenopausal if you are still having menstrual periods. During your perimenopausal years (around the time of menopause), your monthly periods may become irregular. However, you are still considered premenopausal until your periods have stopped for 12 months in a row without a medical reason.

Why should I care about risk assessment?

Osteoporosis is a silent disease that causes bones to become thin and weak, often resulting in broken bones as women age. In fact, did you know that 1 out of 2 women over the age of 50 break a bone as a consequence of osteoporosis? The earlier you know your personal risk factors for osteoporosis, the sooner you can take actions to control the many risk factors that can be changed. Your actions to reduce risk factors can help prevent osteoporosis later in life.

Who is at risk for osteoporosis?

Osteoporosis can happen to anyone – the disease has no age, gender or ethnic boundaries. Osteoporosis more commonly affects the elderly, postmenopausal women, and individuals of Caucasian or Asian descent. This does not mean that others are not at risk for osteoporosis. Men, African-Americans, and other populations get osteoporosis, too; they are just at a slightly lower risk than Caucasian or Asian postmenopausal women.

Am I at risk for osteoporosis?

You may be at risk for osteoporosis if you check “yes” to many of the following risk factors. The more risk factors you check, the greater your risk for osteoporosis and related fractures to occur later in life.

Risk Assessment for Premenopausal Women PDF small print

Risk Assessment for Premenopausal Women PDF large print

Check () if you...

	are Caucasian or Asian
	weigh less than 127 lbs
	have any relatives who have/had osteoporosis (a broken bone of the wrist, hip, leg or spine occurring without major trauma, a height loss of more than 1-1/2 inches, or stooped posture)
	have a personal history of fractures (broken bones) during adulthood without trauma (such as a car accident or severe sports injury)
	have a previous fracture(s) of the spine or x-ray evidence of bone loss
	have ammennorhea (a temporary loss of monthly periods for more than 12 months in a row or infrequent periods for several years not including the time without menstration during pregnancy).
Check if you have any of the following chronic diseases or conditions often associated with osteoporosis:
	AIDS
	chronic lung disease
	Type I diabetes
	eating disorders (anorexia, bulimia)
	hyperparathyroidism (excessive parathyroid hormone)
	hyperthyroidism (excessive thyroid hormone)
	inflammatory bowel disease (IBD)
	kidney disease
	liver disease
	lupus
	malabsorption (from celiac sprue or other gastrointestinal disorders)
	neurological diseases (such as stroke or multiple sclerosis)
	rheumatoid arthritis
	history of bed rest or immobility for more than 6 months
Check if you are taking or have taken any of the following medications:
	blood-thinning agents when necessary for chronic use (such as long-term use of coumadin or heparin)
	chemotherapy
	Dilantin (phenytoin), and some other drugs used to treat seizure disorder or depression
	gonadotropin-releasing hormone agonists (lupron or zoladex) used to treat endometriosis
	immunosuppresants (such as methotrexate or cyclosporin)
	steroids (such as prednisone or cortisone) used for more than 3 months to treat asthma, arthritis or other diseases
	thyroid medications, taken in high doses, or lack of routine blood tests for TSH-level monitoring.
Check if you have a longterm history of any of the following lifestyle risk factors:
	eating a diet low in calcium (eating few if any dairy products or calcium-fortified foods and not taking calcium supplements)
	getting little exercise (less than 60 minutes per week)
	smoking or the use of tobacco products (current smoking of any amount of tobacco or a history of smoking more than 1 pack a day for more than 5 years)
	drinking excessive amounts of alcohol or alcohol abuse

Although risk factors may increase your likelihood of getting osteoporosis, having risk factors does not mean that you have or will get the disease. It is important to know that there may be additional risk factors that have not yet been identified. Premenopausal women who do not have any of the above risk factors for osteoporosis may not be protected from developing the disease.

How can I promote healthy bones during my premenopausal years?

Knowledge of your personal risk factors for osteoporosis should encourage you to take actions to promote healthy bones and motivate you to discuss your concerns with your medical professional. You can make a lifelong commitment to prevent osteoporosis.

Is Bone Mineral Density (BMD) Testing recommended for premenopausal women?

In general, BMD testing is not indicated for women before menopause. There are currently no medications approved for osteoporosis prevention or treatment in healthy premenopausal women. There are a few instances, however, in which BMD testing might be recommended in premenopausal women. Long-term use of steroid medications or glucocorticoids is the most common of these instances. The most common diseases requiring steroid treatment in young women are asthma, rheumatoid arthritis, lupus, inflammatory bowel disease, and multiple sclerosis.

In selected cases, osteoporosis medication may be appropriate for premenopausal women at high risk for osteoporosis. Alendronate sodium (Fosamax) is approved for the treatment of osteoporosis in premenopausal women that is caused by the use of steroid medications. Risedronate sodium (Actonel) is approved for both the prevention and treatment of steroid-induced osteoporosis in premenopausal women.

In addition to the use of longterm steroid medications, there are other conditions that may warrant further evaluation of bone health in premenopausal women. These conditions include ammenorrhea (perhaps as a consequence of anorexia nervosa or the athletic female triad) or multiple fractures (fractures that occur without major trauma such as a car accident).

When you reach menopause (when your menstrual periods have stopped for 12 months in a row) and medication options for treatment are available, it is important to speak to your medical professional about your risk for osteoporosis and the possible need for BMD testing.