Secondary amenorrhea leading to osteoporosis: incidence and prevention

Osteoporosis is widely accepted as a "female disease" occurring primarily in postmenopausal women. The fact that this disease can affect premenopausal women experiencing menstrual dysfunction is less commonly known. Amenorrhea decreases bone density at an age when bone formation should still be occurring. The implications of this failure to attain sufficient bone density during the formative years are frightening. The adverse effects on skeletal strength may lead to devastating outcomes in this subgroup of women, either now or in the future. This article reviews causes, risk factors, and treatments associated with both osteoporosis and amenorrhea. Three causes of secondary amenorrhea are discussed in detail: rigorous physical training, anorexia nervosa, and use of the contraceptive agent medroxyprogesterone acetate injection. A review of the literature is presented in order to establish the link between amenorrhea and osteoporosis. A great many young women may be unknowingly placing themselves at risk for developing osteoporosis. This article includes interventions that may decrease this risk and improve quality of life.