Osteoporosis in young adults: Pathophysiology, diagnosis, and management

S. Ferrari, M. L. Bianchi, J. A. Eisman, A. J. Foldes, S. Adami, D. A. Wahl, J. J. Stepan, M. C. De Vernejoul, J. M. Kaufman

Research output: Contribution to journalArticlepeer-review


Postmenopausal osteoporosis is mainly caused by increased bone remodeling resulting from estrogen deficiency. Indications for treatment are based on low areal bone mineral density (aBMD, T-score≤-2.5), typical fragility fractures (spine or hip), and more recently, an elevated 10-year fracture probability (by FRAX®). In contrast, there is no clear definition of osteoporosis nor intervention thresholds in younger individuals. Low aBMD in a young adult may reflect a physiologically low peak bone mass, such as in lean but otherwise healthy persons, whereas fractures commonly occur with high-impact trauma, i.e., without bone fragility. Furthermore, low aBMD associated with vitamin D deficiency may be highly prevalent in some regions of the world. Nevertheless, true osteoporosis in the young can occur, which we define as a T-score below -2.5 at spine or hip in association with a chronic disease known to affect bone metabolism. In the absence of secondary causes, the presence of fragility fractures, such as in vertebrae, may point towards genetic or idiopathic osteoporosis. In turn, treatment of the underlying condition may improve bone mass as well. In rare cases, a bone-specific treatment may be indicated, although evidence is scarce for a true benefit on fracture risk. The International Osteoporosis Foundation (IOF) convened a working group to review pathophysiology, diagnosis, and management of osteoporosis in the young, excluding children and adolescents, and provide a screening strategy including laboratory exams for a systematic approach of this condition.

Original languageEnglish
Pages (from-to)2735-2748
Number of pages14
JournalOsteoporosis International
Issue number12
Publication statusPublished - Dec 2012


  • Diagnosis
  • IOF
  • Lowbonemass
  • Osteoporosis
  • Secondary osteoporosis
  • Young adults

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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