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Teenage menstrual cycle and bone health.

Health urgings for bone mass density testing and drug advertising for Boniva are usually aimed at menopause-age women and older, making us view osteoporosis as a problem for mature women. In reality, true prevention begins during the teen years, the primary time for building bone mass. Lawrence M. Nelson, MD, writes," ... osteoporosis is a pediatric disease with geriatric consequences. ... Bone density can be compared to a bank account: We need to take care of it when we are young so it is there to take care of us in our old age." Young women who miss the window for bone growth are more susceptible to developing osteoporosis at menopause.

An important and early signal that a woman has a higher risk of osteoporosis is menstrual irregularity as a young woman. Menstrual irregularity with more than 90 days between periods is a sign that the body is not producing enough of the bone-building estrogen estradiol. Menstrual irregularity can have many causes, including too much exercise, emotional stress, eating too few calories, radiation or chemotherapy, androgen excess, and medical conditions like hyperprolactinemia and primary ovarian insufficiency. The longer estrogen deficiency persists, the more likely a young woman will have osteoporosis later in life.

Nelson tells practitioners, "At every medical encounter involving adolescent girls, two questions need to be asked: 1) 'When was your last menstrual period?' and 2) 'Are your periods coming regularly?'" (Practitioners may need to define what they mean by "regularly.") Nelson says to chart these answers along with other vital signs and investigate any abnormalities. By assuming that irregularities are just a part of the early teen years, practitioners can miss an opportunity to prevent the occurrence of osteoporosis later in life.

Nelson LM. The menstrual cycle in adolescents--a vital sign of bone health. Contemp Ob Gyn. March 2010;55(3):32-37.

briefed by Jule Klotter

jule@townsendletter.com

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Title Annotation:Shorts
Author:Klotter, Jule
Publication:Townsend Letter
Article Type:Report
Geographic Code:1USA
Date:Apr 1, 2011
Words:310
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