Question
I am a 32yr old female w/osteopenia -1.4 through hips. I was breastfeeding X 14mo but have stopped. I have a mirena IUD, no problems. I assume I ovulate, periods are irregular and light (Mirena). i take 1500 calcuim w/ vit D and also distance run. My last marathon was 2/07 but have not run distance lately. I have No medical history or allergies. What treatment option is best, removing Mirena and restarting OCP, keep Mirena and take premarin/estrogen (if so how much), or do nothing and recheck it later (If so how long)
Answer
There is little evidence into what defines osteopenia and osteoporosis in premenopausal women. It is fairly clear that the use of the T and Z score from a bone densitometry scan does not represent the same long-term fracture risk in a pre-menopausal women as it does for those past menopause. Oral contraceptive pills are not necessarily a treatment for premenopausal osteopenia, as they approximate physiologic levels of estrogen. For your concerns, consulting with your primary care physician, gynecologist, or an endocrinologist may help to better define whether your bone mass is deficient enough to require an anti-resorptive agent.
