How to manage osteoporosis before the age of 50

Authors: Rozenberg S et al. (2020)

Link: https://www.maturitas.org/article/S0378-5122(20)30261-9/fulltext

Background Information:

Osteoporosis—typically thought of as a disease affecting older adults—can also affect people under 50. For younger individuals, bone health largely depends on reaching a strong peak bone mass during adolescence and early adulthood. This process is shaped by genetics and lifestyle factors like nutrition, exercise, hormone levels, and overall health. Unfortunately, bone development can be disrupted during puberty or by conditions that impact bone-building cells (osteoblasts), leading to weak bones early in life. Unlike older adults, there’s less evidence guiding diagnosis and treatment in younger people, and not everyone with low bone density actually has osteoporosis.

Purpose of the Study:

The review aimed to summarize current approaches for diagnosing and managing osteoporosis in people under 50. The authors explored why early bone weakening occurs—whether due to hidden medical conditions, medications, or lifestyle issues—and sought to guide doctors on when to investigate low bone density, when to recommend lifestyle changes, and when to consider medications.

Methods and Data Analysis:

Rather than original experiments, the authors reviewed existing medical literature and clinical guidelines. They evaluated research on bone mineral density (BMD) testing, looked at causes of secondary osteoporosis in younger adults (like hormone disorders, diabetes, or prior cancer treatments), and assessed evidence for treatments. Recommendations focused on balancing the potential benefits of drug therapy against the limited long-term safety data in younger people.

Key Findings and Conclusions:

The review concluded that not all young adults with low bone density need medical treatment. Clinicians should investigate secondary causes—such as hormonal imbalances, diabetes, or past chemotherapy—and reserve drug therapy only for those with confirmed osteoporosis or fractures. Lifestyle interventions like adequate calcium and vitamin D, physical activity, and addressing underlying conditions can be effective first steps. The authors emphasized caution with medications due to limited evidence in this age group.

Applications & Limitations:

Clinically, this guidance can help doctors avoid overtreatment and focus on improving bone health through lifestyle changes and treating underlying causes. Medications like bisphosphonates or denosumab may be considered in rare cases—such as chemotherapy-induced bone loss or low BMD with fractures. Limitations include a lack of large clinical trials specifically involving young adults, and uncertainty about long-term effects of osteoporosis drugs in people who may still be building peak bone mass.