A Narrative Review on Determinants of Bone Health in Premenopausal Women: Interplay of Hormones, Nutrition, Lifestyle, and Medical Conditions

Abstract

Bone health of premenopausal women has become an important topic due to the rising recognition of bone- related problems and early risk of osteoporosis in this age group. It is determined by several interconnected
factors, including hormonal and nutritional factors, and the presence of chronic diseases. This review aims to synthesize the evidence from various studies, addressing factors that affect bone health in this population.
Estrogen and progesterone play a crucial role in determining bone health, and women with low levels of serum estradiol are more prone to low bone mineral density (BMD) and osteoporosis risk. Ovulatory disturbances
during the menstrual cycle lead to an estrogen–progesterone imbalance. Physical activity is consistently linked to improved skeletal integrity, whereas excessive alcohol consumption and cigarette smoking result in lower bone mass. Medical conditions such as diabetes mellitus, anorexia nervosa, hyperthyroidism, premature ovarian insufficiency, and celiac disease significantly reduce BMD. Findings show that higher protein intake poses no harm to bone health, although its benefits are inconclusive, while contradicting evidence exists regarding the association between Vitamin D and bone health in premenopausal women, and there is inconsistent evidence on the effect of calcium and Vitamin D supplementation. Any disruptions in these factors can limit peak bone mass acquisition or contribute to accelerated bone loss. Identifying and addressing these complex and sometimes contradicting factors is important for developing strategies that support bone health and reduce the risk of fracture
in young women.