Amenorrhea is a common clinical problem, making it important to consider its potential associated morbidity. While osteoporosis has long been recognized in postmenopausal women, bone loss in young premenopausal women is now receiving increasing attention. Many subtypes of amenorrhea are associated with osteopenia and clinical fractures, including hyperprolactinemia, excess exercise, anorexia nervosa, and hypothalamic amenorrhea. In addition, iatrogenic osteopenia may develop in young women treated with GnRH agonists for endometriosis or uterine leiomyomata. Adolescent girls with amenorrhea appear to be at very high risk for osteopenia, supporting the view that adolescence is a critical period for attainment of peak skeletal mass. There are multiple hormonal and other variables that may contribute to premenopausal osteopenia, including low serum levels of estrogen, progesterone, and free testosterone, high serum cortisol levels, and low body weight. In some cases, reversal of amenorrhea with treatment of the underlying disorder results in some improvement in bone density. Knowledge about the sites, severity, and reversibility of bone loss in young amenorrheiac women is important for making decisions about therapy. These topics are addressed in this review.
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