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<text id=90TT3025>
<title>
Nov. 12, 1990: When Bones Are Brittle
</title>
<history>
TIME--The Weekly Newsmagazine--1990
Nov. 12, 1990 Ready For War
</history>
<article>
<source>Time Magazine</source>
<hdr>
MEDICINE, Page 82
When Bones Are Brittle
</hdr>
<body>
<p>Osteoporosis may take root in young women
</p>
<p> The crippling symptoms of osteoporosis have become almost
synonymous with old age. The dowager's hump, the loss of height,
the painful and often debilitating fractures of the spine and
hip nearly always occur in elderly women after menopause (as
well as in a smaller number of older men). And that age group
has been the focus of prevention and treatment efforts.
</p>
<p> Now a controversial report suggests the disease often begins
in younger women who have no outward sign of bone problems. The
findings, reported last week in the New England Journal of
Medicine by a team from the University of British Columbia,
raise the possibility that more than half of all healthy women
in their 30s and 40s could be suffering from bone damage as a
result of subtle, undetected disturbances in their menstrual
cycles. But some experts doubt the conclusions and call for
follow-up trials before doctors change their approach to the
disease.
</p>
<p> Bone, like many tissues, is constantly being broken down and
rebuilt. In younger women this balance is thought to be
maintained, at least in part, by the hormone estrogen. The
sharply reduced production of estrogen after menopause, many
researchers believe, upsets that balance, triggering a gradual
loss of bone tissue. In about one-quarter of women, this
deterioration eventually results in the porous, brittle bones
characteristic of osteoporosis.
</p>
<p> In the new study, however, the researchers were not
examining older women. Instead, they were trying to find out why
one group of young women--marathon runners--seemed to be
peculiarly predisposed to osteoporosis. The researchers
theorized that disruptions in the runners' menstrual cycles
might be at fault. But to their surprise, when they compared the
marathoners with women who ran for recreation and others who
engaged in no special physical activity, the researchers found
that menstrual disturbances were common in all three groups.
</p>
<p> In fact, almost 30% of all cycles experienced by the 66
women over a 12-month span were in some way disrupted. The upset
was caused either by a failure to ovulate (or produce an egg)
or by a shortened "luteal phase," a critical stage of the
menstrual cycle during which the hormone progesterone is
produced. More important the researchers found that these
disturbances were directly related to dramatic bone loss: the
20% who missed ovulation at least once, for example, suffered as
much as a 4% reduction in bone density in one year.
</p>
<p> How might menstrual problems hurt bones? Lead researcher
Jerilynn Prior believes that reduced levels of the hormone
progesterone--which was suppressed in women with cycle
disruptions--may explain the damage. Some studies have
indicated that this hormone helps with bone formation. Prior is
not certain what causes the menstrual disturbances. The most
likely candidate, she says, is stress.
</p>
<p> But other experts are skeptical. Dr. Charles Chesnut III,
director of the Osteoporosis Research Center at the University
of Washington, points out that it would be premature to draw
major conclusions from such a short-term study. Longer trials
are needed to show whether the bone damage is permanent.
Besides, several experts contend, if such dramatic bone loss
were in fact occurring in so many younger women, then it would
have been obvious to doctors before now. If the study was
exactly right, argues Chesnut, "most women would be entering
menopause with no skeletons."
</p>
<p> Yet even if Prior's research overestimates the degree of
bone damage in young women, the study is intriguing evidence
that osteoporosis can at least get started at an early age. If
that is confirmed, the information suggests that preventive
steps--perhaps progesterone therapy--may help some women
ward off the disease before it becomes crippling.
</p>
<p>By Andrew Purvis.
</p>
</body>
</article>
</text>