Aside from lifestyle measures such as calcium intake, vitamin D repletion, and weight-bearing exercises and ruling out all secondary causes, what is the preferred approach to managing osteoporosis in young women with Z score of less than -2.5 and planning to get pregnant soon?

It is very helpful to have some knowledge as to the reason for the Z score of <2.5. Young women with low BMI can have a low Z score just due to the unloading of the skeleton. Increasing body weight can often improve BMD in these women. Presumably, she has a normal menstrual cycle. If not, the instit...

Agree but might be at risk for fractures with pregnancy or postpartum. A 24-hour urine calcium is also recommended to check for hypercalciuria.

PTH analogue use for a few months prior to trying for pregnancy may also be a consideration.