Premenopausal Osteoporosis

Osteoporosis Prevention in Premenopausal Women

Intervention	Guideline
Patient Education	Define osteopenia, osteoporosis, bone mineral density for patient; discuss with patient known risk factors and preventive measures as listed below.
Self Assessment	White or Asian race, weight, menopausal status, nutritional and lifestyle factors.
Family History Assessment	Fracture of a hip, vertebra or wrist in a first-degree relative is a risk factor; vertebral kyphosis or "hump" may be all a woman is aware of in a family member.
Calcium	NIH Guidelines: 1000 mg/day of elemental calcium Carbonate contains 40% elemental calcium; citrate may be better tolerated (less constipation, dyspepsia). Divide doses into 500 mg or 600 mg/dose to improve absorption.
Vitamin D	400 IU/day recommended in women with insufficient sun exposure. Component of most multivitamins.
Exercise	Recommend weight-bearing exercise (weight-lifting, aerobics, etc. as opposed to swimming, bicycling).
Individualized Risk Factor Reduction	Limit alcohol, caffeine intake, concomitant drugs known to affect bone metabolism, particularly corticosteroids

Algorithm for the Diagnosis of Osteoporosis

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