Although osteoporosis is usually considered a disorder of postmenopausal women, certain groups of premenopausal women are also at high risk for osteoporosis through a number of factors such as disease, certain environments and genetic disposition. There have been relatively few studies on screening and treatment for these younger age groups of women and consequently few practice guidelines exist for diagnosis or therapy. In order to increase awareness of high-risk patients, this article presents an overview of important clinical concerns in premenopausal osteoporosis based on a review of over 300 selected articles. The review addresses measurement of bone mass, normal bone accrual, risk factors for premature bone loss, clinical outcomes and management issues. Risk factors for the disease are outlined according to type, such as genetic influence, race, hormonal factors, nutritional factors, physical activity, disease and smoking. Recommendations for further study include further research to clarify the relative importance of risk factors for early bone loss, as well as the development of a useful system for selective screening.