Would you consider an osteoporosis medication in a pre-menopausal/young patient with a low Z score and an ongoing risk factor for secondary osteoporosis such as chronic antiepileptic treatment?

Osteoporosis prevention is always difficult in young patients with risk factors. For young premenopausal women or men below 40, I extrapolate from glucocorticoid-induced osteoporosis (GIOP) guidelines. If Z scores are below -3 and/or there is a history of fragility fracture(s), then treatment with OP meds and maximization of Ca/Vit D supplementation is recommended. Treatment options need to be weighed very carefully given the risk of teratogenicity. The GIOP guidelines suggest oral bisphosphonate first line (some consider risedronate over alendronate as it has less affinity for bone and thus does not stick around as long) and teriparatide second line. If there is no fragility fracture history but there is the low bone density for chronologi...