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Stephanie Halloran
Kelsey Corcoran
Anthony Lisi


Osteoporosis, Osteopenia, Premenopausal, Nutrition, Prevention


Objective: In the United States, Doctors of Chiropractic (DCs) are healthcare providers who may manage patient with osteoporosis or osteopenia. Many physicians are familiar with management approaches pertaining to post-menopausal osteoporosis, but the evidence available for premenopausal osteoporosis and osteopenia are limited. This review aims to provide an overview of prevalence, diagnostic strategies, risk factors and management considerations for premenopausal females as relevant to DCs.

Methods: A search of the PubMed database from January 1, 2003 to December 31, 2019, was conducted using search terms osteoporosis, osteopenia, and premenopausal women. Additional searches were performed as necessary for supplementary information regarding interventions. Data were synthesized based on content relevant to chiropractic practice and presented as a narrative review.

Results: Dual-energy x-ray absorptiometry (DXA) screening is indicated in cases of fragility fracture or significant secondary causes of low bone mineral density in the premenopausal population. For women that are 30-40 years old, perhaps 0.5% have DXA scores consistent with osteoporosis and 15% with osteopenia. Of these cases, 50-90% are influenced by genetic predisposition, increased age, low weight and body mass index, malnourishment, medication use, and related systemic diseases impacting nutrient metabolism, hormone regulation, and autoimmune inflammatory conditions. Management of osteoporosis and osteopenia in at-risk premenopausal women includes referral for primary systemic diseases requiring medical intervention, conservative management targeting nutritional treatment and lifestyle recommendations critical to bone health, and referral for DXA screening and pharmacological interventions as indicated.

Conclusion: There is currently limited evidence regarding osteoporosis and osteopenia in premenopausal women. DCs can employ diagnostic strategies and conservative management strategies, some of which may decrease the risk of development or progression of osteoporosis and osteopenia in this population. The use of conservative strategies for co-managing secondary causes may have the potential to improve long-term management of these conditions.


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