Factors related to variation in premenopausal bone mineral status: A health promotion approach

Bone loss prior to menopause may contribute to later risk of fracture due t o osteoporosis. Women may be able to optimize premenopausal bone mass and/o r prevent losses. Heredity, and possibly age at menarche (retrospectively d etermined), are unmodifiable risk factors and attention should therefore be directed to more amenable factors. Amenorrhea, low body weight, disordered eating, and smoking are modifiable risk factors. Vitamin D is not a factor for premenopausal women who receive incidental sun exposure and consume fo rtified foods, but supplementation should be considered for others, especia lly during the winter months. Protective factors include a higher body weig ht (especially due to increased muscularity), calcium supplementation, and purposeful load-bearing exercise. Positive effects of oral contraceptives a re most apparent in women with menstrual irregularities. Reproductive histo ry (parity), lactation, moderate intakes of alcohol and caffeine, and the a ppropriate treatment of endometriosis have no apparent effect on premenopau sal bone.