Risk Assessment for Premenopausal Women

Am I premenopausal?

You are considered premenopausal if you are still having menstrual periods. During your perimenopausal years (around the time of menopause), your monthly periods may become irregular. However, you are still considered premenopausal until your periods have stopped for 12 months in a row without a medical reason.

Why is it important to assess my risk factors for osteoporosis?

Osteoporosis is a silent disease that causes bones to become thin and weak, often resulting in broken bones as women age. The earlier you know your personal risk factors for osteoporosis, the sooner you can take actions to control the many risk factors that can be changed. Your actions to reduce risk factors may help prevent osteoporosis later in life.

Risk Assessment for Premenopausal Women

Am I at risk for osteoporosis?

You may be at risk for osteoporosis if you check “yes” to many of the following risk factors.

Check () if you…

are Caucasian or Asian
are small and thin
have a parent who has/had osteoporosis or a broken hip
have a personal history of fractures (broken bones) during adulthood without trauma (such as a car accident or severe sports injury)
have a previous fracture(s) of the spine or x-ray evidence of bone loss
have height loss of more than 1-1/2 inches
have amennorhea (a temporary loss of monthly periods for more than 12 months in a row or infrequent periods for several years not including the time without menstruation during pregnancy or breastfeeding)

Check if you have any of the following chronic diseases or conditions often associated with osteoporosis:

autoimmune disease including lupus
blood disorders – certain types such as leukemia, sickle cell disease
cancer – certain types such as breast, lymphoma, various metastatic, multiple myeloma, ovarian
chronic lung disease
eating disorders – anorexia, bulimia
hyperparathyroidism (excessive parathyroid hormone)
hyperthyroidism (excessive thyroid hormone)
inflammatory bowel disease
kidney disease
immobility or bed rest for more than 6 months
liver disease
lung disease that is chronic (COPD)
malabsorption- from bariatric (obesity) surgery, celiac disease, Crohn’s disease, liver disease, pancreatic disease
neurological disorders – (such as multiple sclerosis, Parkinson’s disease, spinal cord injury, stroke)
organ transplant
rheumatoid arthritis

Check if you are taking or have taken any of the following medications:

Important: If you take any of these medications, do not stop or change the way you take them without medical advice from your healthcare provider.

aluminum containing antacids – such as Maalox or Mylanta taken for long periods of time
anti-seizure medications such as dilantin (phenytoin) or phenobarbitol
aromatase inhibitors – such as Arimidex, Aromasin, Femara
blood-thinning agents – such as long-term use of warfarin (Coumadin) or heparin
chemotherapy- some types such as Tamoxifen
diabetes medications: some known as thiazolidinediones (TZDs) such as Actos, Avandia
gonadotropin-releasing hormone agonists (GnRH) – such as Lupron and zoladex used to treat endometriosis
immunosuppressants – cyclosporine A, methotrexate, FK506 (Tacrolimus)
medroxyprogesterone acetate (Depo-Provera) given as an injection for birth control
proton pump inhibitors – such as Nexium, Prevacid, Prilosec
selective serotonin reuptake inhibitors (SSRIs) – such as as Lexapro, Paxil, Prozac, Zoloft
steroids (such as prednisone or cortisone) in a dose of 5 mg or more taken for 3 or more months
thyroid medications taken in excess or lack of routine blood work to check TSH levels

Check if you have a longterm history of any of the following lifestyle risk factors:

low calcium intake – eating few, if any dairy foods or foods with calcium added and not taking calcium supplements
low vitamin D intake – seldom eat fatty fish or drink milk and take no multivitamin or vitamin D supplement
little physical activity – less than 60 minutes per week
smoking – more than 1 pack a day for more than 5 years or current smoking (in any amount)
excessive alcohol intake or alcohol abuse

Although risk factors may increase your likelihood of getting osteoporosis, having risk factors does not mean that you have or will get the disease. It is important to be aware that the above checklist of risk factors is not complete. There are additional conditions and medications that may cause bone loss leading to osteoporosis; some of which are known as well as others that have not yet been identified.

Is bone mineral density (BMD) testing recommended for premenopausal women?

Knowledge of your personal risk factors for osteoporosis should encourage you to take actions for healthy bones and motivate you to discuss your concerns with your healthcare provider. You can make a lifelong commitment to prevent osteoporosis.

Is bone mineral density (BMD) testing recommended for premenopausal women?

In general, BMD testing is not appropriate for premenopausal women. In rare cases, however, BMD testing may be considered. The long-term use of steroid medication is one of the rare reasons for a premenopausal woman to be considered for a BMD test.

How can I promote strong bones during my premenopausal years?

Knowing your personal risk factors for osteoporosis should motivate you to take actions to promote strong bones and encourage you to discuss ways to reduce your risk factors with your healthcare provider. However, you can start here:

  • Eat a variety of healthy (nutrient-rich) foods. Make half of your plate vegetables and fruit, add lean protein, include whole grains, select heart-healthy fats, and remember to include a calcium-rich food or drink at each meal. For more information about healthy food choices, go to www.choosemyplate.gov
  • Reach and maintain a healthy weight. Eat the amount of calories and protein you need. The amount that you need will depend on your height, weight, activity level, and age. It is important to avoid excessive dieting and excessive thinness.
  • Get the calcium you need. It is recommended that adults consume 1000 to 1200 milligrams (mg) of calcium each day. It is best to get calcium from the foods you eat. Foods rich in calcium such as low fat dairy foods (milk, yogurt, cheese), dark green leafy vegetables (bok choy, broccoli, collard greens, kale, mustard greens, and turnip greens), canned fish (sardines, salmon) eaten with bones, or calcium-fortified (with calcium added) foods. The body uses calcium best when it is spaced through the day. Try to eat a calcium rich food at each meal or snack. If you think that you are not getting the recommended amount of calcium in the foods you eat, it is important to consult with your healthcare provider to find out if a calcium supplement is right for you. Calcium supplements should not be taken without the advice of your healthcare provider. Too much calcium taken on a routine basis, particularly from supplements, may be harmful.
  • Get the recommended amount of vitamin D. There are only a few good natural sources of vitamin D including fatty fish such as catfish, eel, mackerel, salmon, sardines, tuna and shiitake mushrooms. Small amounts of vitamin D are added to all cow’s milk, some types of beverages (almond, coconut, rice, or soy beverages and orange juice), yogurt, cheese, and nutrition bars. Adults under 50 years of age should consume 400-800 international units (IU) or 10-20 micrograms (mcg) of vitamin D daily. Adults 50 years of age and above should consume 800-1000 IU or 20-25mcg daily. Your healthcare provider may recommend more vitamin D than above stated amounts based on your individual needs.
  • Be physically active. Your bones get stronger and denser when you make them work. Walking, climbing stairs, and dancing are impact (or weight-bearing) exercises that strengthen your bones by moving your body against gravity when you are standing. Resistance exercises such as lifting weights or using exercise bands strengthens your bones and your muscles too! Tai Chi is an example of physical activity that improves posture and balance to help decrease the risk for falls and fractures. Exercise can be easy; try 10 minutes at a time, adding the minutes up to reach your goal. It is important to stretch properly and avoid excessive exercise.
  • Quit smoking. If you do smoke, stop! Call 1-800-NYQUITS for information about how to quit.
  • Limit alcohol. Before drinking alcohol, it is important to speak to your health care provider about possible interactions with your medication or your medical condition. Too much alcohol can be bad for your bones and your overall health.