Vertebral fractures in a young woman: the impact of hypogonadism, glucocorticoids, and chronic disease
Abstract
Vignette: A premenopausal woman was reviewed for painful vertebral fractures in the context of prednisolone exposure for her newly diagnosed systemic lupus erythematosus (SLE). Known clinical risk factors for bone loss included exposure to depot medroxyprogesterone acetate (MPA) for 12 yr, cigarette smoking, a family history of osteoporosis and ongoing inflammatory arthritis. Initial investigations also identified vitamin D deficiency and low bone mass for age and sex. She was treated with vitamin D, and her contraception was changed to a levonorgestrel intrauterine device. In the context of further vertebral fractures confirmed with both MRI and bone scan and having had additional secondary causes of low bone mass excluded, she commenced targeted osteoporosis treatment. We discuss the complexities of managing bone fragility in young adults and the impact of depot MPA, inflammatory disease (SLE), and glucocorticoid-induced osteoporosis (GIO) on younger adults. In this woman, antiresorptive therapy with zoledronic acid was recommended; we also explore the existing evidence-base for antiresorptive and anabolic therapies in younger adults, with a particular focus on GIO.
Related
- Effects of percutaneous kyphoplasty with concomitant postural reduction in the treatment of acute osteoporotic vertebral compression fractures
- Procedural Complications and Implant Cutout of the SpineJack®-System in Thoracolumbar Vertebral Fractures: A Retrospective Analysis of 204 Implants from a Level-1 Trauma Center
- Association Between Hounsfield Units and Vertebral Body Re-collapse 3 Months After Posterior Fixation for Thoracolumbar Burst Fractures in Working-Age Patients: A Retrospective Register-Based Cohort Study
- Multiple acute vertebral fractures during recovery from myxedema coma.
- Extensive vertebral compression fractures as the initial manifestation of childhood B-cell acute lymphoblastic leukemia despite limited peripheral blood abnormalities: a case report
BibTeX
@article{herath2026vertebral,
title = {{Vertebral fractures in a young woman: the impact of hypogonadism, glucocorticoids, and chronic disease}},
author = {Madhuni Herath and Hanh H Nguyen and Frances Milat and Peter R Ebeling},
journal = {Journal of Bone and Mineral Research},
year = {2026},
month = may,
doi = {10.1093/jbmr/zjag088},
url = {https://doi.org/10.1093/jbmr/zjag088},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Vertebral fractures in a young woman: the impact of hypogonadism, glucocorticoids, and chronic disease
AU - Madhuni Herath
AU - Hanh H Nguyen
AU - Frances Milat
AU - Peter R Ebeling
PY - 2026
DA - 2026/05/23
JO - Journal of Bone and Mineral Research
DO - 10.1093/jbmr/zjag088
UR - https://doi.org/10.1093/jbmr/zjag088
AB - Vignette: A premenopausal woman was reviewed for painful vertebral fractures in the context of prednisolone exposure for her newly diagnosed systemic lupus erythematosus (SLE). Known clinical risk factors for bone loss included exposure to depot medroxyprogesterone acetate (MPA) for 12 yr, cigarette smoking, a family history of osteoporosis and ongoing inflammatory arthritis. Initial investigations also identified vitamin D deficiency and low bone mass for age and sex. She was treated with vitamin D, and her contraception was changed to a levonorgestrel intrauterine device. In the context of further vertebral fractures confirmed with both MRI and bone scan and having had additional secondary causes of low bone mass excluded, she commenced targeted osteoporosis treatment. We discuss the complexities of managing bone fragility in young adults and the impact of depot MPA, inflammatory disease (SLE), and glucocorticoid-induced osteoporosis (GIO) on younger adults. In this woman, antiresorptive therapy with zoledronic acid was recommended; we also explore the existing evidence-base for antiresorptive and anabolic therapies in younger adults, with a particular focus on GIO.
SN - 0884-0431
SN - 1523-4681
ER -