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Manthey C, Cepon-Robins T, Warrener A. Hyperandrogenism associated with polycystic ovary syndrome may have a protective effect against fracture risk in female athletes: A pilot study. Am J Hum Biol 2024; 36:e24070. [PMID: 38488301 DOI: 10.1002/ajhb.24070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVES Polycystic ovary syndrome (PCOS), characterized by polycystic ovaries, anovulation, and hyperandrogenism, is believed to be an evolutionary mismatch disease. Past research has examined PCOS as a uniform disease, despite variation in phenotypes across diagnostic categories, but establishing an evolutionary mismatch requires a focus on individual traits. We suggest PCOS hyperandrogenism may have been beneficial in ancestral environments because it reduced fracture risk and associated morbidity and mortality due to increased bone mineral density (BMD). We test this hypothesis by assessing fracture frequency, a proxy for BMD, in highly active females with and without PCOS hyperandrogenism. METHODS Sixty-seven reproductive-aged women were surveyed and grouped as: high intensity interval training (HIIT; a proxy for metabolic and physical stress) athletes with hyperandrogenic PCOS (31.24%), HIIT athletes without PCOS (29.85%), and nonathletes with hyperandrogenic PCOS (38.81%). Fracture occurrence was compared between the groups using independent samples Kruskal-Wallis tests for non-normally distributed data, and multiple regression analysis was used to examine anthropometrics, lifestyle and reproductive factors, PCOS status, and exercise frequency on fracture occurrence. RESULTS Fracture occurrence was higher in non-PCOS athletes (3.8 ± 4.3) than PCOS-athletes (1.2 ± 1.4, p = .11) and PCOS-non-athletes (1.0 ± 1.4, p < .01). PCOS-athletes and nonathletes did not differ significantly in fracture occurrence (p = .33). These results were independent of factors associated with bone health. CONCLUSIONS These preliminary findings suggest females with PCOS-related hyperandrogenism may be less likely to experience bone fractures and provide an initial step to explaining why PCOS has persisted despite marked negative reproductive consequences in modern populations.
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Affiliation(s)
- Courtney Manthey
- The University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Tara Cepon-Robins
- The University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Anna Warrener
- The University of Colorado Denver, Denver, Colorado, USA
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Mujica LKS, dos Santos Amaral C, Valente FS, Miyazato LG, Macari S, da Silva TA, Barrioni BR, Carlos BL, Silva GJA, Shimano AC, Antoniazzi AQ, Premaor MO, Comim FV. Bone strength is reduced in a neonatal androgenized rat model. Bone Rep 2023; 19:101710. [PMID: 37637757 PMCID: PMC10458295 DOI: 10.1016/j.bonr.2023.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/29/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023] Open
Abstract
Background Whether polycystic ovary syndrome (PCOS) affects bone health during a woman's lifespan remains controversial. An androgenized rodent model replicated many metabolic and reproductive features of women with PCOS, and we aimed to use it to investigate the impact of androgens on microarchitecture (by micro-CT), bone mechanical strength, bone formation and resorption markers in rats with intact ovaries (SHAM) who underwent oophorectomy. Methods Wistar rats (Rattus norvegicus albinus) were employed for the experiments in this study. The protocol of androgenization consisted of the application of 1.25 mg s.c. testosterone propionate beteween days 2-5 of life, while the controls received the same amount of corn oil s.c. as previously established. Androgenized SHAM rats exhibited chronic anovulation identified by vaginal cytology and a reduction in the proportion of corpus luteum in the ovary in comparison to control SHAM rats. The realization of the ovariectomy or SHAM procedure occurred on Day 100 of life. All groups (n = 8) were followed-up for 180 days to address the study endpoints. Results Micro-CT from androgenized female rats (SHAM) showed a divergence between the trabecular and cortical bone profiles. Compared to SHAM controls, these rats had an increase in trabecular bone mass with a diminution in bone resorption C-terminal telopeptide of type 1 collagen (CTX) (p < 0.05), a concomitant decrease in cortical area and thickness in the femur, and a reduction in the strength of the femur on the mechanical test (p < 0.01). Conclusions Our results suggest that a reduction in the cortical thickness and cortical area observed in PCOS model rats was associated with a reduced strength of the femur, despite increased trabecular formation. Ovariectomy in the androgenized OVX group limited the progression rate of cortical bone loss, resulting in bone resistance and cortical thickness comparable to those observed in the control OVX group.
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Affiliation(s)
| | - Carolina dos Santos Amaral
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | | | - Ligia Gomes Miyazato
- Animal Care Facility, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Soraia Macari
- Department of Oral Pathology and Surgery, Faculty of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida da Silva
- Department of Oral Pathology and Surgery, Faculty of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Breno Rocha Barrioni
- Department of Metallurgical and Materials Engineering, Faculty of Engineering, Federal University of Minas Gerais, Belo Horizonte (UFMG), Minas Gerais, Brazil
| | - Bruna Leonel Carlos
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Faculty of Medicine, University of Sao Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Jafroni Alves Silva
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Faculty of Medicine, University of Sao Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Antônio Carlos Shimano
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Faculty of Medicine, University of Sao Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Alfredo Quites Antoniazzi
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Melissa Orlandin Premaor
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Fabio Vasconcellos Comim
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Prior JC, Shirin S, Goshtasebi A. Bone health and prevalent fractures in women with polycystic ovary syndrome: a meta-analysis and endocrine-context pathophysiology review. Expert Rev Endocrinol Metab 2023; 18:283-293. [PMID: 37254511 DOI: 10.1080/17446651.2023.2216294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Bone health in those with Polycystic Ovary Syndrome (PCOS) is complex, but the general consensus is that cortical areal bone mineral density (aBMD) sites will be higher in PCOS than in age- and BMI-similar controls. However, spine aBMD sites may be lower, especially in non-obese PCOS. Whether or not incident fracture risk is increased in PCOS is currently controversial; no meta-analysis has yet assessed prevalent fractures. AREAS COVERED We assessed the bone effects of PCOS-related ovarian hormone alterations, e.g. androgen excess, tonically normal/higher estradiol, and lower-than-normal progesterone levels. We also highlighted evidence that common PCOS medications (e.g. combined hormonal contraceptives [CHC], metformin, and spironolactone) have important bone effects. In adolescents, meta-analysis of CHC showed significant negative aBMD changes. Inflammation has negative PCOS bone effects and is linked with CHC use. EXPERT OPINION Is fracture risk altered by PCOS? Our meta-analysis showed a 25% increased risk of prevalent fracture in PCOS versus controls; this did not reach statistical significance. Future prospective research needs to collect and evaluate ovulation characteristics, progesterone exposure, and adolescent CHC use, in addition to the complex variables that may influence risks for prevalent or incident fragility fractures and/or for cortical and cancellous aBMD values in PCOS.
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Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia, University Endowment Lands, Canada
- Division of Endocrinology, Department of Medicine, University of British Columbia, University Endowment Lands, Canada
- Women's Health Research Institute, University of British Columbia, University Endowment Lands, Canada
- School of Population and Public Health, University of British Columbia, University Endowment Lands, Canada
| | - Sonia Shirin
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia, University Endowment Lands, Canada
- Women's Health Research Institute, University of British Columbia, University Endowment Lands, Canada
| | - Azita Goshtasebi
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia, University Endowment Lands, Canada
- Women's Health Research Institute, University of British Columbia, University Endowment Lands, Canada
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Noroozzadeh M, Amiri M, Farhadi-Azar M, Ramezani Tehrani F. Bone Health in Women With Polycystic Ovary Syndrome: A Narrative Review. J Clin Densitom 2022; 25:606-614. [PMID: 35430131 DOI: 10.1016/j.jocd.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
Bone as an active connective and endocrine tissue is influenced by hormones, physical activity, inflammatory factors, minerals, dietary components, and body weight. Bone fractures are a major cause of decreased quality of life and mortality in humans. Polycystic ovary syndrome (PCOS), is one of the most common endocrine disorders in women of reproductive age worldwide. PCOS is associated with disturbances in androgen and estrogen levels, insulin resistance (IR), obesity, as well as low-grade chronic inflammation, and gut microbiota (GM) dysbiosis, all of which may negatively or positively affect bone metabolism. However, it has not yet been well clarified whether PCOS is bone-protective or bone-destructive. This study aimed to review the association between bone health and PCOS, and summarize its related factors. PubMed, Scopus, and Web of Science databases were searched to retrieve relevant English publications investigating the relationship between bone health and PCOS. Several disorders associated with PCOS can negatively or positively affect bone metabolism. Despite some positive effects of insulin, androgens, estrogens, and obesity on bone, IR, estrogen deficiency, low-grade chronic inflammation, and GM dysbiosis may adversely affect the bone metabolism in PCOS women. Studies comparing bone mineral density or bone metabolism and the risk of bone fractures in women with PCOS have controversial results. Further studies are required to understand the mechanisms underlying bone metabolism in PCOS subjects. Moreover, prospective studies are needed to estimate the risk of bone fractures and osteoporosis in PCOS subjects.
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Affiliation(s)
- Mahsa Noroozzadeh
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahbanoo Farhadi-Azar
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Association between testosterone levels and bone mineral density in females aged 40-60 years from NHANES 2011-2016. Sci Rep 2022; 12:16426. [PMID: 36180560 PMCID: PMC9525583 DOI: 10.1038/s41598-022-21008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Growing evidence indicates that testosterone is a conspicuous marker for assessing male bone mineral density (BMD). However, research regarding testosterone levels and BMD is sparse and controversial for females. Hence, we aimed to investigate the association between testosterone levels and BMD among adult females aged 40–60 years in the United States. In this cross-sectional study, all participants were part of the National Health and Nutrition Examination Survey (2011–2016). A weighted general linear model was used to estimate the association between testosterone levels and lumbar BMD. Age, race, income level, education level, body mass index (BMI), blood urea nitrogen (BUN) level, serum uric acid (UA) level, serum calcium (Ca) level, serum phosphorus (P) level, the use of oral contraceptive pills, the use of hormone replacement therapy (HRT), smoking status, drinking status, and the use of corticosteroids were adjusted using a weighted multiple regression model. Subgroup analyses were performed using the same regression model. We included 2198 female participants in the study, and testosterone levels were positively associated with lumbar BMD after adjusting for all the covariates (β = 1.12, 95% CI 0.31, 1.93). In subgroup analyses, the associations in the fourth quartile of testosterone levels were stronger for the participants aged 40–50 years old (quartile 4, β = 42.92, 95% CI 7.53, 78.30 vs. quartile 1) and 50 to 60-year-old (quartile 4, β = 32.41, 95% CI 0.14, 64.69 vs. quartile 1). Similar results were found in other subgroups, including subgroups for race (Non-Hispanic Black, Other), income level (income ≤ 1.3, income > 3.5), education level (college or higher), BMI > 25 kg/m2, BUN levels ≤ 20 mg/dL, UA levels ≤ 6 mg/dL, Ca levels ≤ 10.1 mg/dL, P levels ≤ 5 mg/dL, drinking status, never smoker, never taking birth control pills, and HRT user. There was no interaction among the covariates in the association between lumbar BMD and testosterone levels (P for interaction > 0.05). In US adult females aged 40–60 years, the testosterone level was a positive predictor of the lumbar BMD after adjusting for covariates.
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Zia A, Hakim S, Khan AU, Bey A, Ateeq H, Parveen S, Khalid S, Yusufi F. Bone markers and bone mineral density associates with periodontitis in females with poly-cystic ovarian syndrome. J Bone Miner Metab 2022; 40:487-497. [PMID: 35072780 DOI: 10.1007/s00774-021-01302-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/10/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Studies suggest an association between poly-cystic ovarian syndrome (PCOS) and chronic periodontitis (CP), both being inflammatory conditions. However, insufficient evidence assesses the impact of this inflammation on bone metabolism and bone turnover markers (BTMs). The present study aimed to determine the association between BTMs, bone mineral density (BMD), and clinical periodontal parameters in PCOS women with CP. MATERIALS AND METHODS Three groups, each with 40 newly diagnosed (1) PCOS+CP, (2) PCOS alone, (3) CP alone, and fourth group (n = 20) systemically and periodontally healthy females aged 18-30 years were included in the study. Full mouth clinical periodontal parameters, C-terminal telopeptides of type I collagen (CTX), bone alkaline phosphatase (ALP), BMD and 25-hydroxyvitamin D (VD) were recorded for all. RESULTS Low BMD (0.89 ± 0.11 g/cm2), increased CTX levels (2.76 ± 4.64 ng/ml), decreased bone ALP levels (11.09 ± 6.86 ng/ml), higher VD levels (289.02 ± 168.28 nmol/l) and poor clinical periodontal status were observed in PCOS + CP females. BMD-spine showed weak positive correlation with CTX, bone ALP, VD (r = 0.02, r = 0.07, r = 0.15, respectively) in PCOS + CP group. ANCOVA depicted covariates had no confounding effect. Multiple regression model explained 21.0% for BMD-spine and 12.7% for BMD-femur of total variability signifying association with all measured parameters among all groups. CONCLUSION Enhanced inflammatory thrust by periodontitis increases CTX levels and decreases bone ALP and BMD levels in women with PCOS. Screening PCOS women for periodontal disease and vice versa may have a direct bearing on overall bone health.
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Affiliation(s)
- Afaf Zia
- Department of Periodontics and Community Dentistry, Dr. Ziauddin Ahmed Dental College (DRZADC), Aligarh Muslim University (AMU), Aligarh, 202002, Uttar Pradesh, India.
| | - S Hakim
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital (JNMCH), AMU, Aligarh, Uttar Pradesh, India
| | - A U Khan
- Interdisciplinary Biotechnology Unit, AMU, Aligarh, Uttar Pradesh, India
| | - A Bey
- Department of Periodontics and Community Dentistry, Dr. Ziauddin Ahmed Dental College (DRZADC), Aligarh Muslim University (AMU), Aligarh, 202002, Uttar Pradesh, India
| | - H Ateeq
- Department of Biochemistry, AMU, Aligarh, Uttar Pradesh, India
| | - S Parveen
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital (JNMCH), AMU, Aligarh, Uttar Pradesh, India
| | - S Khalid
- Interdisciplinary Biotechnology Unit, AMU, Aligarh, Uttar Pradesh, India
| | - Fnk Yusufi
- Department of Statistics and Operations, AMU, Aligarh, Uttar Pradesh, India
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Deshmukh H, Shah N, Papageorgiou M, Abdalla MA, Lhaf F, Aye M, Sathyapalan T. Genetic risk for the polycystic ovary syndrome, bone mineral density and fractures in women and men: A UK Biobank Mendelian randomisation study. Bone 2022; 155:116285. [PMID: 34902614 DOI: 10.1016/j.bone.2021.116285] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION There is conflicting data on the effect of polycystic ovary syndrome (PCOS) on bone mineral density (BMD) and fracture risk. Recent genetic data suggest that men may also carry genetic risk factors for PCOS; the associations of these factors with parameters of bone health remains unknown. We aimed to investigate if the genetic risk of PCOS is associated with BMD and fracture risk in women and men in the UK Biobank dataset. METHODS We used Mendelian randomisation (MR) analysis to test the association of genetic risk of excess testosterone in PCOS with BMD and fractures in the UK biobank study. The MR analysis was performed using linear regression analysis with the weighted genetic risk score (wGRS) as an independent variable adjusting for age, BMI and population eigenvectors. The horizontal pleiotropy in the MR analysis was tested using MR-Egger regression analysis. RESULTS The study consisted of 221,086 Caucasian women (mean age ± SD: 56.7 ± 7.9 years, mean body mass index [BMI] ± SD: 27.0 ± 5.1 kg/m2, mean BMD ± SD: 0.50 ± 0.11 g/cm2) and 187,816 Caucasian men (mean age ± SD: 57.1 ± 8.1 years, mean BMI ± SD: 27.7 ± 4.1 kg/m2 and mean BMD ± SD: 0.56 ± 0.12 g/cm2). Women and men self-reported 24,797 (11%) and 17,076 (10%) fractures over the last 5 years, respectively. The MR analysis showed that one SD increase in the wGRS for clinical or biochemical hyperandrogenism in PCOS was associated with significantly higher heel BMD (Beta = 0.0007 [±0.0002], P-value = 0.001) and a significantly reduced risk of fractures (OR = 0.97, P-value = 0.003) in women. A similar wGRS in men was not associated with BMD or risk of fractures. CONCLUSION In this study, we showed that the excess genetic risk for hyperandrogenism in women with PCOS is associated with a higher BMD and reduced risk of fractures.
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Affiliation(s)
- Harshal Deshmukh
- University of Hull, UK; Hull University Teaching Hospital NHS Trusts, UK
| | - Najeeb Shah
- University of Hull, UK; Hull University Teaching Hospital NHS Trusts, UK
| | | | | | | | - Mo Aye
- Hull University Teaching Hospital NHS Trusts, UK
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Turcotte AF, O’Connor S, Morin SN, Gibbs JC, Willie BM, Jean S, Gagnon C. Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis. PLoS One 2021; 16:e0252487. [PMID: 34101735 PMCID: PMC8186797 DOI: 10.1371/journal.pone.0252487] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population. OBJECTIVES This systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. individuals without obesity: 1) the incidence of fractures overall and by site; 2) BMD; and 3) bone quality parameters (circulating bone turnover markers and bone microarchitecture and strength by advanced imaging techniques). DATA SOURCES PubMed (MEDLINE), EMBASE, Cochrane Library and Web of Science were searched from inception of databases until the 13th of January 2021. DATA SYNTHESIS Each outcome was stratified by sex and menopausal status in women. The meta-analysis was performed using a random-effect model with inverse-variance method. The risks of hip and wrist fracture were reduced by 25% (n = 8: RR = 0.75, 95% CI: 0.62, 0.91, P = 0.003, I2 = 95%) and 15% (n = 2 studies: RR = 0.85, 95% CI: 0.81, 0.88), respectively, while ankle fracture risk was increased by 60% (n = 2 studies: RR = 1.60, 95% CI: 1.52, 1.68) in postmenopausal women with obesity compared with those without obesity. In men with obesity, hip fracture risk was decreased by 41% (n = 5 studies: RR = 0.59, 95% CI: 0.44, 0.79). Obesity was associated with increased BMD, better bone microarchitecture and strength, and generally lower or unchanged circulating bone resorption, formation and osteocyte markers. However, heterogeneity among studies was high for most outcomes, and overall quality of evidence was very low to low for all outcomes. CONCLUSIONS This meta-analysis highlights areas for future research including the need for site-specific fracture studies, especially in men and premenopausal women, and studies comparing bone microarchitecture between individuals with and without obesity. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42020159189.
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Affiliation(s)
- Anne-Frédérique Turcotte
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec (QC), Canada
- Obesity, Type 2 Diabetes and Metabolism Unit, Institut universitaire de cardiologie et de pneumologie de Québec–Université Laval Research Center, Québec (QC), Canada
- Department of Medicine, Faculty of Medicine, Laval University, Québec (QC), Canada
| | - Sarah O’Connor
- Institut universitaire de cardiologie et de pneumologie de Québec–Université Laval Research Center, Québec (QC), Canada
- Department of Pharmacy, Faculty of Pharmacy, Laval University, Québec (QC), Canada
- Bureau d’information et études en santé des populations, Institut national de santé publique du Québec, Québec (QC), Canada
| | - Suzanne N. Morin
- Department of Medicine, Faculty of Medicine, McGill University, Montreal (QC), Canada
| | - Jenna C. Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal (QC), Canada
| | - Bettina M. Willie
- Department of Pediatric Surgery, Shriners Hospital for Children-Canada, Research Centre, McGill University, Montreal (QC), Canada
| | - Sonia Jean
- Department of Medicine, Faculty of Medicine, Laval University, Québec (QC), Canada
- Bureau d’information et études en santé des populations, Institut national de santé publique du Québec, Québec (QC), Canada
| | - Claudia Gagnon
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec (QC), Canada
- Obesity, Type 2 Diabetes and Metabolism Unit, Institut universitaire de cardiologie et de pneumologie de Québec–Université Laval Research Center, Québec (QC), Canada
- Department of Medicine, Faculty of Medicine, Laval University, Québec (QC), Canada
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Di Bari F, Catalano A, Bellone F, Martino G, Benvenga S. Vitamin D, Bone Metabolism, and Fracture Risk in Polycystic Ovary Syndrome. Metabolites 2021; 11:metabo11020116. [PMID: 33670644 PMCID: PMC7922814 DOI: 10.3390/metabo11020116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among premenopausal women. PCOS may have reproductive, metabolic, cardiovascular, and psychological implications. Vitamin D deficit is often encountered in PCOS women and may contribute to the pathophysiology of this disorder. As of the key role of vitamin D in bone and mineral metabolism, and because the vitamin D status appears to be closely linked with the PCOS manifestations including insulin resistance, obesity, ovulatory and menstrual irregularities, oxidative stress and PTH elevation, hypovitaminosis D may directly and indirectly via the different facets of PCOS impair bone health in these women. Although limited data are available on life-long fracture risk in women with PCOS, the importance of preserving bone health in youth and adults to prevent osteoporosis and related fractures is also recognized in PCOS women. Evidence of the association between vitamin D and the clinical hallmarks of PCOS are summarized and discussed. Vitamin D arises as a cornerstone in women with PCOS and contributes to the pathophysiological link between PCOS and bone metabolism.
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Affiliation(s)
- Flavia Di Bari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Viale Gazzi, 98125 Messina, Italy; (F.D.B.); (F.B.); (G.M.); (S.B.)
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Viale Gazzi, 98125 Messina, Italy; (F.D.B.); (F.B.); (G.M.); (S.B.)
- Correspondence: ; Tel.: +39-090-2213987
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Viale Gazzi, 98125 Messina, Italy; (F.D.B.); (F.B.); (G.M.); (S.B.)
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Viale Gazzi, 98125 Messina, Italy; (F.D.B.); (F.B.); (G.M.); (S.B.)
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Viale Gazzi, 98125 Messina, Italy; (F.D.B.); (F.B.); (G.M.); (S.B.)
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Viale Gazzi, 98125 Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology and Women’s Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, Viale Gazzi, 98125 Messina, Italy
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Mujica LKS, Glanzner WG, Prante AL, Rissi VB, Correa GRE, Premaor MO, Antoniazzi AQ, Gonçalves PBD, Comim FV. Trabecular Bone is Increased in a Rat Model of Polycystic Ovary Syndrome. Exp Clin Endocrinol Diabetes 2020; 129:757-761. [PMID: 33113570 DOI: 10.1055/a-1284-5491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Polycystic ovary syndrome (PCOS) in an intricate disorder characterized by reproductive and metabolic abnormalities that may affect bone quality and strength along with the lifespan. The present study analysed the impact of postnatal androgenization (of a single dose of testosterone propionate 1.25 mg subcutaneously at day 5 of life) on bone development and markers of bone metabolism in adult female Wistar rats. Compared with healthy controls, the results of measurements of micro-computed tomography (microCT) of the distal femur of androgenized rats indicated an increased cortical bone volume voxel bone volume to total volume (VOX BV/TV) and higher trabecular number (Tb.n) with reduced trabecular separation (Tb.sp). A large magnitude effect size was observed in the levels of circulating bone formation Procollagen I N-terminal propeptide (P1NP) at day 60 of life; reabsorption cross-linked C-telopeptide of type I collagen (CTX) markers were similar between the androgenized and control rats at days 60 and 110 of life. The analysis of gene expression in bone indicated elements for an increased bone mass such as the reduction of the Dickkopf-1 factor (Dkk1) a negative regulator of osteoblast differentiation (bone formation) and the reduction of Interleukin 1-b (Il1b), an activator of osteoclast differentiation (bone reabsorption). Results from this study highlight the possible role of the developmental programming on bone microarchitecture with reference to young women with PCOS.
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Affiliation(s)
- Lady Katerine Serrano Mujica
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, RS
| | - Werner Giehl Glanzner
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, RS
| | - Amanda Luiza Prante
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, RS
| | - Vitor Braga Rissi
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, RS
| | | | - Melissa Orlandin Premaor
- Department of Clinical Medicine, Federal University of Santa Maria (UFSM), Santa Maria, RS.,MOP and FVC are now at the Department of Clinical Medicine, Federal University of Minas Gerais, Belo Horizonte, MG
| | - Alfredo Quites Antoniazzi
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, RS
| | - Paulo Bayard Dias Gonçalves
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, RS
| | - Fabio Vasconcellos Comim
- Laboratory of Biotechnology and Animal Reproduction - BioRep, Federal University of Santa Maria (UFSM), Santa Maria, RS.,Department of Clinical Medicine, Federal University of Santa Maria (UFSM), Santa Maria, RS.,MOP and FVC are now at the Department of Clinical Medicine, Federal University of Minas Gerais, Belo Horizonte, MG
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11
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The Relationship Between Polycystic Ovarian Syndrome, Periodontal Disease, and Osteoporosis. Reprod Sci 2020; 28:950-962. [PMID: 32914348 DOI: 10.1007/s43032-020-00310-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 02/01/2023]
Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder to affect women in their reproductive years. There has been growing concern that women with PCOS may suffer from long-term metabolic consequences due to the high degree of insulin resistance that is often present in PCOS. However, few longitudinal studies exist in this area and there is a paucity of data on whether women with PCOS are at risk of other chronic diseases as they age. Specifically, current evidence suggests that reproductive-age women with PCOS may be at increased risk for both osteoporosis and periodontal disease (PD)-both these chronic diseases can have serious implications for health and quality of life. However, few studies have addressed how risk factors for osteoporosis and PD may be altered by aging in PCOS. The PCOS phenotype of women beyond reproductive years is poorly understood, and it is not known whether the metabolic profile of older women with PCOS results in an increased risk of osteoporosis and PD. The objective of this review is to discuss the relationships between PCOS, osteoporosis, and PD, and how these relationships could be impacted during aging. The long-term goal of this review is to provide direction for future research that is needed to more clearly elucidate these relationships and eventually provide a basis for evidence-based health recommendations.
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12
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Abstract
Polycystic ovary syndrome (PCOS) has been extensively studied in reproductive-aged women. However, accumulating research shows that PCOS can have lifelong effects on multiple aspects of women's health. PCOS can affect the onset and course of menopause and cardiovascular health in perimenopausal and postmenopausal patients. Moreover, PCOS may increase a woman's risk for both gynecologic and nongynecologic malignancies. When treating older PCOS patients, physicians should be cognizant of the syndrome's long-term effects and consider the unique needs of these women.
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13
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Piovezan JM, Premaor MO, Comim FV. Negative impact of polycystic ovary syndrome on bone health: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:633-645. [PMID: 31374576 DOI: 10.1093/humupd/dmz020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/24/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) has reproductive and metabolic aspects that may affect bone health. Controversial results from different studies regarding the risk of fractures, bone mineral density (BMD) or bone markers led to uncertainty whether PCOS might improve or deteriorate bone health. OBJECTIVE AND RATIONALE This study aimed to investigate the impact of PCOS on bone markers, BMD and fracture risk. SEARCH METHODS A systematic review and a meta-analysis were carried out. PubMed, EMBASE and Cochrane databases were searched for eligible studies from 1st of January of 1990 to 9th of October of 2018. Eligible studies enrolled women older than 18 years with PCOS, which should be diagnosed according to the Rotterdam Consensus, the Androgen Excess Society, the National Institutes of Health Consensus or the International Classification of Diseases. The studies were grouped according to patient mean BMI: <27 kg/m2 or ≥27 kg/m2. The results were polled as mean difference (MD), standardized MD (SMD) and hazard ratio (HR). OUTCOMES Overall, 921 studies were retrieved, and 31 duplicated studies were removed. After screening the titles and abstracts, 80 studies were eligible for full text reading. Of those, 23 studies remained for qualitative synthesis. With the exception of one study, all studies were considered high quality based on the Newcastle-Ottawa scale (NOS; score ≥6). Meta-analysis was performed in 21 studies, with a total of 31 383 women with PCOS and 102 797 controls. Women with PCOS with BMI <27 kg/m2 had lower BMD of the total femur (MD, -0.04; 95% CI, -0.07 to 0.00; I2 = 31%; P = 0.22) and spine (MD, -0.07; 95% CI, -0.13 to -0.01; I2 = 70%; P < 0.01) when compared with the control group, whereas for women with BMI ≥27 kg/m2 no difference was observed (femur: MD, 0.02; 95% CI, -0.02 to 0.05; I2 = 20%, P = 0.29; spine: MD, 0.02; 95% CI, -0.06 to 0.05; I2 = 0%; P = 0.84). Osteocalcin was remarkably reduced in women with PCOS with BMI <27 kg/m2 (SMD, -2.68; 95% CI, -4.70 to -0.67; I2 = 98%; P < 0.01), but in women with BMI ≥27 kg/m2, there were no differences between PCOS and controls. Few studies (n = 3) addressed the incidence of bone fractures in women with PCOS. The HR for total bone fractures did not identify differences between women with PCOS and controls. WIDER IMPLICATIONS On the basis of the available evidence, it is possible to assume that PCOS in women with BMI <27 kg/m2 is associated with reduced BMD in the spine and femur, and decreased bone formation, as manifested by lower levels of circulating osteocalcin. These findings suggest that bone parameters in PCOS may be linked, to some extent, to adiposity. These studies included premenopausal women, who have already achieved peak bone mass. Hence, further prospective studies are necessary to clarify the existence of increased risk of fractures in women with PCOS.
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Affiliation(s)
- Júlia Mottecy Piovezan
- Post Graduation Program, Health Sciences Professional Master, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Melissa Orlandin Premaor
- Post Graduation Program, Health Sciences Professional Master, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Fábio Vasconcellos Comim
- Post Graduation Program, Health Sciences Professional Master, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
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14
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Yue D, Li Fei S, Jing C, Ru Xin W, Rui Tong D, Ai Lian L, Luo YH. The relationship between calcium (water) density and age distribution in adult women with spectral CT: initial result compared to bone mineral density by dual-energy X-ray absorptiometry. Acta Radiol 2019; 60:762-768. [PMID: 30249113 DOI: 10.1177/0284185118801139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Calcium (water) density (DCa(Wa)) of gemstone spectral imaging by spectral computed tomography (CT) is a new method of evaluating bone structures. PURPOSE To investigate age-related change of DCa(Wa) of a chosen lumbar vertebra in adult women with spectral CT and the correlation between the DCa(Wa) and bone mineral density (BMD) of dual-energy X-ray absorptiometry (DXA). MATERIAL AND METHODS A total of 305 adult women underwent spectral CT, 127 of whom simultaneously underwent DXA. All the patients were divided into 11 subgroups based on age. DCa(Wa) and BMD were measured at the second lumbar vertebra on the calcium (water)-based material decomposition images of spectral CT and DXA, respectively. A one-way analysis of variance (ANOVA) was performed for the difference of the measurements among adjacent age subgroups. Pearson correlation was used to assess the association between age and DCa(Wa), age and BMD, as well as DCa(Wa) and BMD. RESULTS There was a significant negative correlation between DCa(Wa) and age (r = -0.719) as well as BMD and age(r = -0.851). The mean DCa(Wa) of L2 vertebral body was significantly different between the 40-44- and 45-49-, 45-49- and 50-54-, 55-59- and 60-64-, 65-69- and 70-74-year-old age subgroups. BMD was significantly different between the 35-39- and 40-44-, 45-49- and 50-54-, and 65-69- and 70-74-year-old age subgroups. There was a significant positive correlation between DCa(Wa) and BMD. CONCLUSIONS The DCa(Wa) of lumbar vertebra by spectral CT demonstrated similar age distribution as BMD of DXA and could be used as a method of measuring the vertebral bone mineral density in adult women.
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Affiliation(s)
- Dong Yue
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, Shenyang, Liaoning, PR China
| | - Sun Li Fei
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Chen Jing
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Wang Ru Xin
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Dong Rui Tong
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, Shenyang, Liaoning, PR China
| | - Liu Ai Lian
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Ya Hong Luo
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, Shenyang, Liaoning, PR China
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15
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Yang HY, Lee HS, Huang WT, Chen MJ, Chen SCC, Hsu YH. Increased risk of fractures in patients with polycystic ovary syndrome: a nationwide population-based retrospective cohort study. J Bone Miner Metab 2018; 36:741-748. [PMID: 29280078 DOI: 10.1007/s00774-017-0894-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/25/2017] [Indexed: 12/18/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a complex disorder; various features of this disorder may influence bone metabolism and skeletal mass. The contribution of PCOS to lower bone mineral density has been recognized. However, the impact of PCOS on the long-term risks for fractures remains inconclusive. The aim of this study was to determine the risk of overall fracture and fractures at different anatomic sites in patients with PCOS. Using a nationwide health insurance claims database, we included 11,106 subjects, aged 15-80 years, with newly diagnosed PCOS (ICD-9-CM: 254.4X) during 2000-2012. Patients with PCOS and respective age-matched (1:4) controls without PCOS were enrolled. The occurrence of fracture was monitored until the end of 2013. Cox regression and computed hazard ratios (HR) with 95% confidence intervals (95% CI) were used to determine the risk of PCOS among women with fractures. The PCOS and non-PCOS groups were comprised of 11,106 patients with PCOS and 44,424 participants without PCOS, respectively. Patients with PCOS had a higher incidence of any fractures compared with non-PCOS group (10.16 versus 8.07 per 1000 person-years) and a greater risk of any fractures [adjusted hazard ratio (aHR) = 1.23, 95% CI = 1.13-1.33], osteoporotic fractures (aHR = 1.33, 95% CI = 1.15-1.54), spine fractures (aHR = 1.36, 95% CI = 1.11-1.66) and forearm fractures (aHR = 1.39, 95% CI = 1.07-1.80), but the risk for femur or hip fracture, humerus, wrist and non-osteoporotic fractures were not increased. In conclusion, the PCOS group had a higher occurrence rate of fractures than the non-PCOS group. These results provide evidence for the adverse effects of PCOS on the risk of fractures.
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Affiliation(s)
- Hsin-Yi Yang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 813, Taiwan
| | - Wan-Ting Huang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan
| | - Ming-Jer Chen
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Solomon Chih-Cheng Chen
- Heng Chun Christian Hospital, Pingtung County, 946, Taiwan
- Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Yueh-Han Hsu
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan.
- Department of Medical Research, China Medical University Hospital and China Medical University, Taichung, 404, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhong-Xiao Road, Chia-Yi, 600, Taiwan.
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, 736, Taiwan.
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16
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Xafaki P, Balanika A, Pergantou H, Papakonstantinou O, Platokouki H. Impact of target joint and FVIII inhibitor οn bone properties in children with haemophilia A: A peripheral quantitative computed tomography study. Haemophilia 2018; 24:800-806. [PMID: 30088693 DOI: 10.1111/hae.13591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/22/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Haemophilic children are prone to low bone mass accrual. OBJECTIVE To assess bone properties in haemophilic children, using peripheral quantitative computed tomography (pQCT) and to correlate findings with clinical data. SUBJECTS/METHODS Peripheral quantitative computed tomography scan of both radii and tibiae were performed in 31 haemophilic A children (severe 24, mean age 11.2 years). Seven subjects had a history of inhibitors. Five children had an upper extremity target-joint and 12 had at least one lower extremity target-joint. The following parameters were measured: trabecular, total and cortical bone density and content (TBD, ToBD, CBD, TbC, CC), strength-stress index (SSI), and tibial cross-sectional area (CA), outer and inner bone contour length (PERI, ENDO) and cortical thickness (CTHC). RESULTS Mean right radius TBD was significantly higher than the left one (P = 0.015). In subjects with arm target-joint, radius TBD was significantly lower in the target than in non-target arm (186.6 ± 60.4 vs 218.6 ± 39.8, P = 0.032). Left arm target-joint subjects had significantly lower left radius TBD in comparison to subjects without arm target-joint (155.4 ± 50.3 vs 215.7 ± 37.9, P = 0.019). There were no similar differences in leg target-joint. Bone quality and geometry parameters in cortical compartment were significantly lesser in inhibitor group, with statistically significant side-to-side differences for legs and arms and left side predominance. CONCLUSION In children with haemophilia A and a history of target-joint and/or FVIII inhibitor, abnormalities may occur in the long bones as were revealed by pQCT, where low trabecular density and weak cortical bone quality in upper and lower extremities, respectively, were confirmed.
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Affiliation(s)
- Panagiota Xafaki
- Haemophilia Centre- Haemostasis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Alexia Balanika
- Second Radiology Department, "Attikon" University Hospital, Athens, Greece
| | - Helen Pergantou
- Haemophilia Centre- Haemostasis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - Helen Platokouki
- Haemophilia Centre- Haemostasis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
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17
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Lingaiah S, Morin-Papunen L, Piltonen T, Puurunen J, Sundström-Poromaa I, Stener-Victorin E, Bloigu R, Risteli J, Tapanainen JS. Bone markers in polycystic ovary syndrome: A multicentre study. Clin Endocrinol (Oxf) 2017; 87:673-679. [PMID: 28845895 DOI: 10.1111/cen.13456] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/11/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Hyperandrogenism, hyperinsulinaemia and obesity, known characteristics of polycystic ovary syndrome (PCOS), may influence bone mineral density and biochemical markers of bone turnover (BTMs) can provide a noninvasive assessment of bone turnover. To this end, the serum concentrations of BTMs and 25-hydroxyvitamin D (25OHD) were analysed in women with PCOS, and their possible associations with metabolic parameters of PCOS were determined. SUBJECTS AND METHODS Bone formation markers procollagen type I amino-terminal propeptide (PINP) and osteocalcin (OC), and bone resorption marker carboxy-terminal cross-linking telopeptide of type I collagen (CTX), along with 25OHD, were measured in 298 women with PCOS and 194 healthy controls. RESULTS Serum levels of PINP (47.0 ± 20.2 vs 58.1 ± 28.6 μg/L, P < .001) and OC (18.2 ± 7.5 vs 20.6 ± 9.8 μg/L, P < .001) were decreased in women with PCOS compared with controls, whereas no significant differences were found in CTX and 25OHD levels. Age-stratified analyses suggested that PINP (50.5 ± 21.7 vs 68.2 ± 26.6 μg/L, P < .001) and OC levels (20.4 ± 7.6 vs 25.5 ± 9.6 μg/L, P < .001) were decreased only in the younger age group (≤30 years) women with PCOS compared with controls. The formation markers and resorption marker decreased with age in both study groups. CONCLUSIONS Bone formation markers were decreased in younger women with PCOS when compared with healthy women, which may affect bone mass in these women.
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Affiliation(s)
- Shilpa Lingaiah
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johanna Puurunen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | | | | - Risto Bloigu
- Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland
| | - Juha Risteli
- Department of Clinical Chemistry, Oulu University Hospital, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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18
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Trakakis E, Pergialiotis V, Hatziagelaki E, Panagopoulos P, Salloum I, Papantoniou N. Subclinical hypothyroidism does not influence the metabolic and hormonal profile of women with PCOS. Horm Mol Biol Clin Investig 2017; 31:/j/hmbci.ahead-of-print/hmbci-2016-0058/hmbci-2016-0058.xml. [PMID: 28672734 DOI: 10.1515/hmbci-2016-0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/07/2017] [Indexed: 11/15/2022]
Abstract
Background Subclinical hypothyroidism (SCH) is present in 5%-10% of polycystic ovary syndrome (PCOS) patients. To date, its impact on the metabolic and hormonal profile of those women remains controversial. The purpose of our study is to evaluate the impact of SCH on the glycemic, lipid and hormonal profile of PCOS patients. Materials and methods We conducted a prospective case control study of patients that attended the Department of Gynecological Endocrinology of our hospital. Results Overall, 280 women with PCOS were enrolled during a time period of 7 years (2009-2015). Twenty-one patients (7.5%) suffered from SCH. The anthropometric characteristics were comparable among women with PCOS and those with SCH + PCOS. The prevalence of acne, hirsutism and anovulation did not differ. Significant differences were observed in the 2-h oral glucose tolerance test (OGTT) (p = 0.003 for glucose and p = 0.046 for insulin). The QUICKI, Matsuda and homeostatic model assessment-insulin resistance (HOMA-IR) indices where, however, similar. No difference in serum lipids was observed. Slightly elevated levels of follicle stimulating hormone (FSH) and testosterone were noted. The remaining hormonal parameters remained similar among groups. Similarly, the ovarian volume and the endometrial thickness did not differ. Conclusions The impact of SCH on the metabolic and hormonal profile of PCOS patients seems to be negligible. Future studies are needed in the field and their conduct in a multi-institutional basis seems to be required, given the small prevalence of SCH among women with PCOS.
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19
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Kalyan S, Patel MS, Kingwell E, Côté HCF, Liu D, Prior JC. Competing Factors Link to Bone Health in Polycystic Ovary Syndrome: Chronic Low-Grade Inflammation Takes a Toll. Sci Rep 2017; 7:3432. [PMID: 28611442 PMCID: PMC5469792 DOI: 10.1038/s41598-017-03685-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/03/2017] [Indexed: 01/03/2023] Open
Abstract
Chronic inflammation predisposes to poor bone health. Women with polycystic ovary syndrome (PCOS) experience androgen excess, ovulatory disturbances, insulin resistance, abdominal adiposity and chronic inflammation. Our objective was to investigate the relationships among bone health parameters, chronic subclinical inflammation and anthropometric measures in premenopausal women with and without PCOS. In 61 premenopausal women, 22 women with PCOS and 39 controls, we assessed bone parameters (total hip bone mineral density [BMD] by dual-energy X-ray absorptiometry and radius strength-strain index [SSI] by peripheral quantitative computed tomography), inflammation (C-reactive protein/albumin), oxidative stress (leukocyte telomere length, urinary 8-hydroxydeoxyguanosine); hemoglobin A1c; anthropometric measures (body mass index, waist-to-height ratio, cross-sectional muscle area). A diagnosis of PCOS negatively predicted (beta = -0.251, p = 0.022) hip BMD in a regression model including weight. In women with PCOS, inflammation, which was predicted by increased waist-to-height ratio and current use of oral contraceptives, attenuated the positive influences of increased weight and muscle mass on bone strength and was inversely associated with radial SSI (R2 = 0.25, p = 0.018). In conclusion, chronic subclinical inflammation may negatively impact bone physiology in women with PCOS. Strategies focused on reducing abdominal adiposity and avoiding medications that increase inflammation may counter this effect.
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Affiliation(s)
- Shirin Kalyan
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, Department of Medicine, University of British Columbia; Vancouver Coastal Health Research Institute, Vancouver, Canada.
- Women's Health Research Institute, Vancouver, Canada.
| | - Millan S Patel
- Deptartment of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Elaine Kingwell
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, Department of Medicine, University of British Columbia; Vancouver Coastal Health Research Institute, Vancouver, Canada
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Hélène C F Côté
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, Department of Medicine, University of British Columbia; Vancouver Coastal Health Research Institute, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Danmei Liu
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, Department of Medicine, University of British Columbia; Vancouver Coastal Health Research Institute, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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20
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Almeida M, Laurent MR, Dubois V, Claessens F, O'Brien CA, Bouillon R, Vanderschueren D, Manolagas SC. Estrogens and Androgens in Skeletal Physiology and Pathophysiology. Physiol Rev 2017; 97:135-187. [PMID: 27807202 PMCID: PMC5539371 DOI: 10.1152/physrev.00033.2015] [Citation(s) in RCA: 466] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Estrogens and androgens influence the growth and maintenance of the mammalian skeleton and are responsible for its sexual dimorphism. Estrogen deficiency at menopause or loss of both estrogens and androgens in elderly men contribute to the development of osteoporosis, one of the most common and impactful metabolic diseases of old age. In the last 20 years, basic and clinical research advances, genetic insights from humans and rodents, and newer imaging technologies have changed considerably the landscape of our understanding of bone biology as well as the relationship between sex steroids and the physiology and pathophysiology of bone metabolism. Together with the appreciation of the side effects of estrogen-related therapies on breast cancer and cardiovascular diseases, these advances have also drastically altered the treatment of osteoporosis. In this article, we provide a comprehensive review of the molecular and cellular mechanisms of action of estrogens and androgens on bone, their influences on skeletal homeostasis during growth and adulthood, the pathogenetic mechanisms of the adverse effects of their deficiency on the female and male skeleton, as well as the role of natural and synthetic estrogenic or androgenic compounds in the pharmacotherapy of osteoporosis. We highlight latest advances on the crosstalk between hormonal and mechanical signals, the relevance of the antioxidant properties of estrogens and androgens, the difference of their cellular targets in different bone envelopes, the role of estrogen deficiency in male osteoporosis, and the contribution of estrogen or androgen deficiency to the monomorphic effects of aging on skeletal involution.
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Affiliation(s)
- Maria Almeida
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Michaël R Laurent
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Vanessa Dubois
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Frank Claessens
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Charles A O'Brien
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Roger Bouillon
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Dirk Vanderschueren
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
| | - Stavros C Manolagas
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Departments of Cellular and Molecular Medicine and Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium; Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; and Institut National de la Santé et de la Recherche Médicale UMR1011, University of Lille and Institut Pasteur de Lille, Lille, France
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Ünlütürk U, Sezgin E, Yildiz BO. Evolutionary determinants of polycystic ovary syndrome: part 1. Fertil Steril 2016; 106:33-41. [DOI: 10.1016/j.fertnstert.2016.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/15/2016] [Accepted: 05/16/2016] [Indexed: 12/22/2022]
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Comim FV, Marchesan LQ, Copes RM, de Vieira AR, Moresco RN, Compston JE, Premaor MO. Increased risk of humerus and lower leg fractures in postmenopausal women with self-reported premenopausal hirsutism and/or oligomenorrhea. Eur J Obstet Gynecol Reprod Biol 2016; 203:162-6. [PMID: 27318183 DOI: 10.1016/j.ejogrb.2016.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 05/05/2016] [Accepted: 05/13/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of fracture in women aged >55 years with self-reported premenopausal hirsutism and/or oligomenorrhea. STUDY DESIGN A cross-sectional study including 1057 post-menopausal women aged >55 years who were treated in a primary care facility in Santa Maria, South Brazil, from March 2013 through August 2013. Data were collected using a standardized questionnaire for characteristics including fracture history, medication use, and reproductive history (oligomenorrhea, hirsutism, miscarriage, the diagnosis or treatment of hypothyroidism, hyperprolactinemia, or infertility). RESULTS A non-significant trend towards an increased prevalence of all fragility fractures was observed in women with premenopausal hirsutism and/or oligomenorrhea when compared to those without (20.4% vs. 15.7%). After correction for age, falls, and comorbidities, fracture prevalence was significantly higher in the lower leg (OR 3.1 [CI 1.1-8.6]; P=0.029), and humerus (OR 2.6 [CI 1.2-5.4]; P=0.015) in the women with hirsutism and/or oligomenorrhea. CONCLUSION This is a hypothesis-generating study which evaluated the association between hirsutism and/or oligomenorrhea and fractures in postmenopausal women. Our results suggest that premenopausal hirsutism and/or oligomenorrhea may be associated with an increased risk of fracture postmenopause, particularly in the humerus and lower leg.
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Affiliation(s)
- Fabio V Comim
- Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil.
| | - Luana Q Marchesan
- Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Rafaela M Copes
- Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Adhan R de Vieira
- Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Rafael N Moresco
- Pharmaceutical Science, Postgraduate Course, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Melissa O Premaor
- Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
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Rubin KH, Glintborg D, Nybo M, Andersen M, Abrahamsen B. Fracture Risk Is Decreased in Women With Polycystic Ovary Syndrome: A Register-Based and Population-Based Cohort Study. J Bone Miner Res 2016; 31:709-17. [PMID: 26542642 DOI: 10.1002/jbmr.2737] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/26/2015] [Accepted: 11/04/2015] [Indexed: 01/12/2023]
Abstract
Hyperandrogenism, obesity, and hyperinsulinemia may protect against osteoporosis, whereas amenorrhea, increased cortisol, and low growth hormone may be associated with higher fracture risk in polycystic ovary syndrome (PCOS). The objective of this study was to investigate fracture risk in PCOS. In the PCOS Denmark study, women with PCOS and/or hirsutism were identified in the Danish National Patient Register (1995-2012). Each patient was assigned three age-matched controls on the index date of PCOS diagnosis. Individuals with a previous endocrine diagnosis were excluded. Within PCOS Denmark, we embedded a well-characterized subcohort of patients, PCOS OUH, diagnosed with PCOS at Odense University Hospital (n = 1217). We identified incident fractures by International Classification of Diseases, 10th Revision (ICD-10) codes and used conditional Cox regression analyses to compare fracture risk. In the PCOS Denmark study, there were 19,199 women with PCOS and 57,483 controls were included, mean age 30.6 years (range, 12-60 years). Fracture rates were decreased in PCOS Denmark (10.3/1000 patient years) versus controls (13.6/1000 patient years). The adjusted ORs were 0.76 (95% CI, 0.71 to 0.80) for all fractures, 0.82 (95% CI, 0.74 to 0.92) for major osteoporotic fractures, and 0.57 (95% CI, 0.47 to 0.70) for fractures of head and face. The risk reduction was more pronounced below the age of 30 years at diagnosis. Women with PCOS had significant more hospital contacts due to strains and sprains. In the PCOS OUH subcohort, the risk reduction of fractures did not differ between PCOS women with elevated versus normal testosterone levels and the risk reduction was nominally smaller in overweight versus normal weight PCOS women. Women with PCOS had reduced risk of fractures, in particular of the appendicular skeleton. The risk reduction was greater in women with younger age at diagnosis suggesting that the skeletal effects of PCOS may be greater in women who have not yet reached peak bone mass. Reduced participation in sports activities was probably not the reason for the reduced risk of fractures.
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Affiliation(s)
- Katrine Hass Rubin
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.,Department of Medicine, Holbaek Hospital, Holbaek, Denmark
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24
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Moran LJ, Thomson RL, Buckley JD, Noakes M, Clifton PM, Norman RJ, Brinkworth GD. Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome. Endocrine 2015; 50:811-5. [PMID: 25957668 DOI: 10.1007/s12020-015-0625-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with features including hyperandrogenism and menstrual irregularity frequently treated with hormonal steroidal contraceptives. Women with PCOS appear to have lower bone mineral density (BMD). While steroidal contraceptives may positively affect bone health, their effect on BMD in PCOS is not known. The aim of this study was to assess BMD in women with PCOS according to recent contraceptive use. A cross-sectional analysis of 95 pre-menopausal overweight or obese sedentary women with PCOS [age 29.4 ± 6.4 years, body mass index (BMI) 36.1 ± 5.3 kg/m(2)] who either recently took steroidal contraceptives (ceased 3 months prior) or were not taking steroidal contraceptives was conducted. Clinical outcomes included BMD, anthropometry, insulin, glucose, reproductive hormones, dietary intake and vitamin use. BMD was significantly lower for women who used contraceptives compared to those who did not (mean difference 0.06 g/cm(2) 95 % confidence interval -0.11, -0.02, p = 0.005). In regression models, lower BMD was independently associated with contraceptive use (β = -0.05, 95 % CI -0.094, -0.002, p = 0.042), higher testosterone (β = -0.03, 95 % CI -0.05, -0.0008, p = 0.043) and lower BMI (β = 0.006, 95 % CI 0.002, 0.01, p = 0.007) (r (2) = 0.22, p = 0.001 for entire model). We report for the first time that overweight and obese women with PCOS with recent steroidal contraceptive use had lower BMD in comparison to non-users independent of factors known to contribute to BMD. Whether this observation is directly related to steroidal contraceptive use or other factors requires further investigation.
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Affiliation(s)
- Lisa J Moran
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA, 5006, Australia.
| | - R L Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - J D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - M Noakes
- Fertility SA, Adelaide, SA, Australia
| | - P M Clifton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - R J Norman
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide, SA, 5006, Australia
- Fertility SA, Adelaide, SA, Australia
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Maliqueo M, Benrick A, Alvi A, Johansson J, Sun M, Labrie F, Ohlsson C, Stener-Victorin E. Circulating gonadotropins and ovarian adiponectin system are modulated by acupuncture independently of sex steroid or β-adrenergic action in a female hyperandrogenic rat model of polycystic ovary syndrome. Mol Cell Endocrinol 2015; 412:159-69. [PMID: 25963796 DOI: 10.1016/j.mce.2015.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/21/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
Acupuncture with combined manual and low-frequency electrical stimulation, or electroacupuncture (EA), reduces endocrine and reproductive dysfunction in women with polycystic ovary syndrome (PCOS), likely by modulating sympathetic nerve activity or sex steroid synthesis. To test this hypothesis, we induced PCOS in rats by prepubertal implantation of continuous-release letrozole pellets (200 µg/day) or vehicle. Six weeks later, rats were treated for 5-6 weeks with low-frequency EA 5 days/week, subcutaneous injection of 17β-estradiol (2.0 µg) every fourth day, or a β-adrenergic blocker (propranolol hydrochloride, 0.1 mg/kg) 5 days/week. Letrozole controls were handled without needle insertion or injected with sesame oil every fourth day. Estrous cyclicity, ovarian morphology, sex steroids, gonadotropins, insulin-like growth factor I, bone mineral density, and gene and protein expression in ovarian tissue were measured. Low-frequency EA induced estrous-cycle changes, decreased high levels of circulating luteinizing hormone (LH) and the LH/follicle-stimulating hormone (FSH) ratio, decreased high ovarian gene expression of adiponectin receptor 2, and increased expression of adiponectin receptor 2 protein and phosphorylation of ERK1/2. EA also increased cortical bone mineral density. Propranolol decreased ovarian expression of Foxo3, Srd5a1, and Hif1a. Estradiol decreased circulating LH, induced estrous cycle changes, and decreased ovarian expression of Adipor1, Foxo3, and Pik3r1. Further, total bone mineral density was higher in the letrozole-estradiol group. Thus, EA modulates the circulating gonadotropin levels independently of sex steroids or β-adrenergic action and affects the expression of ovarian adiponectin system.
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Affiliation(s)
- Manuel Maliqueo
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Laboratorio de Endocrinología y Metabolismo, Departamento de Medicina Occidente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Anna Benrick
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Asif Alvi
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Julia Johansson
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Miao Sun
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Fernand Labrie
- Laval University Research Center in Molecular Endocrinology, Oncology and Human Genomics, CHUL Research Center, Quebec G1V 4G2, Canada
| | - Claes Ohlsson
- Department of Internal Medicine, Institute of Medicine, Centre for Bone and Arthritis Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Elisabet Stener-Victorin
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China.
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Gaudio A, Muratore F, Fiore V, Rapisarda R, Signorelli SS, Fiore CE. Decreased bone cortical density at the forearm in subjects with subclinical peripheral arterial disease. Osteoporos Int 2015; 26:1747-53. [PMID: 25672808 DOI: 10.1007/s00198-015-3057-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/28/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED The association between peripheral arterial disease (PAD) and low bone mass is controversial. In our study, peripheral quantitative computed tomography shows a reduction of cortical but not trabecular, bone mineral density (BMD) at the forearm, in patients with subclinical PAD. INTRODUCTION Some controversy exists regarding the association between peripheral arterial disease (PAD) and low bone mass. Previous studies have evaluated bone mineral density (BMD) in patients with subclinical PAD, with mixed results. Inconsistency of data may depend on the fact that most studies measured areal bone mineral density (aBMD) by Dual-energy-x ray absorptiometry (DXA). Because DXA cannot distinguish between cortical and trabecular compartments, we reasoned that a study aimed to establish whether these compartments were differentially affected by PAD status could give more information on the nature of this association. METHODS In this cross-sectional study, we used peripheral quantitative computed tomography (pQCT) to examine volumetric cortical and trabecular mineral density at the radius (vBMD) in a cohort of subjects with subclinical PAD as defined by ABI ≤0.90 and compared them with healthy subjects with no evidence of PAD. RESULTS Patients with subclinical PAD had significantly reduced cortical density (1101.0 ± 45.4 vs 1156.2 ± 51.3 mg/cm(3), p < 0.001) and cortical area (75.0 ± 20.9 vs 99.9 ± 18.2 mm(2), p < 0.001) than healthy subjects. Trabecular density (178.1 ± 47.9 vs 165.8 ± 29.6 mg/cm(3)) was not significantly different in the two groups. CONCLUSION Subclinical PAD induces a selective bone loss at the radius compartment, not identified by standard DXA, which seems to occur primarily at the cortical level.
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Affiliation(s)
- A Gaudio
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - F Muratore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - V Fiore
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - R Rapisarda
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - S S Signorelli
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - C E Fiore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy.
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Katulski K, Slawek S, Czyzyk A, Podfigurna-Stopa A, Paczkowska K, Ignaszak N, Podkowa N, Meczekalski B. Bone mineral density in women with polycystic ovary syndrome. J Endocrinol Invest 2014; 37:1219-24. [PMID: 25245338 PMCID: PMC4245449 DOI: 10.1007/s40618-014-0175-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/08/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE PCOS is a complex disorder and various features of this disorder may have great importance for bone metabolism. The aim of the study was to determine the relationship between existing hormonal disorders, and bone mineral density (BMD) in young women with PCOS. METHODS 69 reproductive-aged PCOS women and 30 age-matched healthy controls were enrolled to the study women. In each individual we assessed the body mass index (BMI). We evaluated the serum concentrations of: gonadotropins, prolactin (PRL), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS), testosterone (T), thyroid stimulating hormone (TSH), free thyroxine (fT4). We used the Homeostatic Model Assessment-Insulin Resistance Index (HOMA-IR) to diagnose insulin resistance. Bone mineral density in the lumbar spine was measured by dual-energy X-ray absorptiometry (DXA). RESULTS The PCOS women had lower BMD values as compared to the controls (1.057 ± 0.1260 vs. 1.210 ± 0.1805 g/cm(2), p < 0.0002). In the analysis of PCOS patients according to BMI, only in the subgroup of the normal weight PCOS we find significantly lower BMD in comparison to controls (p = 0.0049). In patients with PCOS, BMD was positively correlated with insulin concentration and HOMA-IR. In the controls Z-score values were positively correlated with insulin concentration and HOMA-IR. CONCLUSIONS The deleterious effect of estrogen deficiency on bones in PCOS is not balanced by androgen overproduction. Women with PCOS had significantly lower BMD of the lumbar spine compared to controls. Insulin seems to be one of the most important positive bone growth stimulators.
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Affiliation(s)
- K. Katulski
- The Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - S. Slawek
- Students Scientific Association of the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - A. Czyzyk
- The Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - A. Podfigurna-Stopa
- The Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - K. Paczkowska
- Students Scientific Association of the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - N. Ignaszak
- Students Scientific Association of the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - N. Podkowa
- Students Scientific Association of the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - B. Meczekalski
- The Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
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Wilson JL, Chen W, Dissen GA, Ojeda SR, Cowley MA, Garcia-Rudaz C, Enriori PJ. Excess of nerve growth factor in the ovary causes a polycystic ovary-like syndrome in mice, which closely resembles both reproductive and metabolic aspects of the human syndrome. Endocrinology 2014; 155:4494-506. [PMID: 25211588 PMCID: PMC4197978 DOI: 10.1210/en.2014-1368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Polycystic ovarian syndrome (PCOS), the most common female endocrine disorder of unknown etiology, is characterized by reproductive abnormalities and associated metabolic conditions comprising insulin resistance, type 2 diabetes mellitus, and dyslipidemia. We previously reported that transgenic overexpression of nerve growth factor (NGF), a marker of sympathetic hyperactivity, directed to the ovary by the mouse 17α-hydroxylase/C17-20 lyase promoter (17NF mice), results in ovarian abnormalities similar to those seen in PCOS women. To investigate whether ovarian overproduction of NGF also induces common metabolic alterations of PCOS, we assessed glucose homeostasis by glucose tolerance test, plasma insulin levels, and body composition by dual-energy x-ray absorptiometry scan in young female 17NF mice and wild-type mice. 17NF mice exhibited increased body weight and alterations in body fat distribution with a greater accumulation of visceral fat compared with sc fat (P < .01). 17NF mice also displayed glucose intolerance (P < .01), decreased insulin-mediated glucose disposal (P < .01), and hyperinsulinemia (P < .05), which, similar to PCOS patients, occurred independently of body weight. Additionally, 17NF mice exhibited increased sympathetic outflow observed as increased interscapular brown adipose tissue temperature. This change was evident during the dark period (7 pm to 7 am) and occurred concomitant with increased interscapular brown adipose tissue uncoupling protein 1 expression. These findings suggest that overexpression of NGF in the ovary may suffice to cause both reproductive and metabolic alterations characteristic of PCOS and support the hypothesis that sympathetic hyperactivity may contribute to the development and/or progression of PCOS.
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Affiliation(s)
- Jenny L Wilson
- Monash Obesity and Diabetes Institute/Department of Physiology (J.L.W., W.C., M.A.C., P.J.E.), Monash University, Clayton, 3800 Victoria, Australia; Division of Neuroscience (G.A.D., S.R.O.), Oregon Health and Science University, Portland, Oregon 97239; and Department of Paediatrics (C.G.-R.), Faculty of Medicine, Nursing and Health Sciences, Monash University and Monash Children's Hospital, Monash Health, Clayton, 3168 Victoria, Australia
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Li D, Hitchcock CL, Barr SI, Yu T, Prior JC. Negative Spinal Bone Mineral Density Changes and Subclinical Ovulatory Disturbances—Prospective Data in Healthy Premenopausal Women With Regular Menstrual Cycles. Epidemiol Rev 2013; 36:137-47. [DOI: 10.1093/epirev/mxt012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Polycystic ovary syndrome (PCOS) is the most frequent endocrinopathy in reproductive-aged women. The majority of hirsute patients are diagnosed with PCOS. Hyperandrogenemia, central obesity and insulin resistance may protect patients with PCOS from osteoporosis, whereas increased cortisol levels, low growth hormone and amenorrhea may be associated with decreased bone mineral density (BMD). Recent studies suggested that insulin resistance in PCOS is associated with decreased vitamin D levels that could not be explained by obesity alone. Vitamin D treatment may therefore have positive effects on insulin sensitivity and perhaps also hyperandrogenemia in patients with PCOS. In the present article, we review the evidence of changed BMD, bone mineral turnover and vitamin D status in PCOS and hirsutism compared with healthy women and the effects of medical intervention on BMD in PCOS.
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Affiliation(s)
- Dorte Glintborg
- a Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Anne Pernille Hermann
- a Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Marianne Andersen
- a Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Maïmoun L, Coste O, Philibert P, Briot K, Mura T, Galtier F, Castes-de-Paulet B, Mariano-Goulart D, Sultan C, Paris F. Testosterone secretion in elite adolescent swimmers does not modify bone mass acquisition: a 1-year follow-up study. Fertil Steril 2012; 99:270-278. [PMID: 23084566 DOI: 10.1016/j.fertnstert.2012.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 08/03/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate whether high plasma testosterone (T) levels affect areal bone mineral density (aBMD), bone geometry, and bone remodeling in young elite female swimmers (SW). DESIGN Cross-sectional and 1-year follow-up study. SETTING Pediatric endocrinology and gynecology units. PARTICIPANT(S) Twenty-five SW and 21 control subjects (CON) with breast stages IV or V (mean age 15.3 ± 1.3 y). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical and biologic parameters, aBMD, and bone geometry. RESULT(S) Two groups of SW were constituted on the basis of total T level. High T level SW (HSW; n = 15) presented higher T than SW with normal T (NSW; n = 10) and CON (0.63 ± 0.17; 0.36 ± 0.07, and 0.38 ± 0.14 ng/mL, respectively). The SHBG level (62.1 ± 18.7 vs. 43.3 ± 19.8 nmol/L) and the LH/FSH ratio (1.7 ± 1.1 vs. 0.9 ± 0.5) were higher, and menstrual disorders (60% vs. 23.8%) were more frequent in HSW than CON, and no difference was observed between the three groups for other sex hormones and insulin-like growth factor (IGF) 1 or IGF-binding protein 3. SW presented lower fat mass in the whole body and higher lean mass in the upper limbs only. aBMD was only modestly increased in the upper limbs in the SW groups, but no other bone-specific differences (aBMD, bone geometry, bone turnover markers) were demonstrated between SW and CON at baseline or for aBMD after 1 year in a subgroup of participants. CONCLUSION(S) High plasma T levels have no detectable effect on bone mass and bone geometry in SW during the period of peak bone mass acquisition.
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Affiliation(s)
- Laurent Maïmoun
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France
| | - Olivier Coste
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France; Direction Régionale de la Jeunesse, des Sports et de la Cohésion Sociale, Montpellier, France
| | - Pascal Philibert
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France
| | - Karine Briot
- Service de Rhumatologie, Hôpital Cochin, APHP Paris, France
| | - Thibault Mura
- Centre d'Investigation Clinique et Département d'information Médicale, CHRU Montpellier, Montpellier, France; CIC 1001, INSERM, Montpellier, France
| | - Florence Galtier
- CIC 1001, INSERM, Montpellier, France; Centre d'Investigation Clinique et Département des Maladies Endocriniennes, CHRU Montpellier, Montpellier, France
| | | | - Denis Mariano-Goulart
- Service de Médecine Nucléaire, Hôpital Lapeyronie, CHRU Montpellier, Montpellier, France
| | - Charles Sultan
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France; Unité d'Endocrinologie et Gynécologie Pédiatrique, Hôpital A. de Villeneuve, CHRU Montpellier et UMI, Montpellier, France.
| | - Françoise Paris
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France; Unité d'Endocrinologie et Gynécologie Pédiatrique, Hôpital A. de Villeneuve, CHRU Montpellier et UMI, Montpellier, France
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To WWK, Wong MWN. A comparison of bone mineral density in normal weight and obese adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2012; 25:248-53. [PMID: 22840935 DOI: 10.1016/j.jpag.2011.12.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 12/20/2011] [Accepted: 12/27/2011] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE To evaluate whether there are any differences in bone mineral density (BMD) between normal weight and obese adolescents suffering from polycystic ovary syndrome (PCOS) with oligo/amenorrhea. DESIGN Prospective cohort study. SETTING Adolescent gynecology clinic in a general service hospital. PARTICIPANTS Subjects consisted of adolescents between 16 to 18 years of age presenting with oligo/ amenorrhea with ultrasound morphology of polycystic ovaries ± evidence of hyperandrogenism over 24 months. Controls consisted of consecutive eumenorrheic patients within the same age group. INTERVENTIONS All underwent full hormonal profile assessment, and dual energy X-ray absorptiometry and peripheral quantitative computed tomography scans. MAIN OUTCOME MEASURES Areal and volumetric BMD parameters. RESULTS Of 37 adolescents with PCOS, 12 (32%) were obese with BMI ≥25, of which 9/12 (75%) were hyperandrogenic. The control group consisted of 40 normal weight eumenorrheic girls. The PCOS group overall had lower lumbar spine BMD values as compared to the controls (0.91 vs 0.97 g/ cm(2), P = 0.033). The normal weight PCOS group had lower BMD at the spine (0.90 vs 0.97 g/ cm(2), P = 0.027), trochanter (0.66 vs 0.71 g/ cm(2), P = 0.039) as well as volumetric distal tibial core sites (268 vs 296 mg/ cm(3)) as compared to eumenorrheic controls, but there were no significant BMD differences between the obese PCOS group and the eumenorrheic controls. CONCLUSIONS Normal weight PCOS adolescents with oligo/amenorrhea have marginally lower BMD values than controls, but obese PCOS adolescents have BMD values compatible with eumenorrheic adolescents.
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Affiliation(s)
- William W K To
- Department of Obstetrics and Gynecology, United Christian Hospital, Kowloon, Hong Kong SAR.
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Schmidt J, Dahlgren E, Brännström M, Landin-Wilhelmsen K. Body composition, bone mineral density and fractures in late postmenopausal women with polycystic ovary syndrome - a long-term follow-up study. Clin Endocrinol (Oxf) 2012; 77:207-14. [PMID: 22385110 DOI: 10.1111/j.1365-2265.2012.04378.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Hyperandrogenism is one of the characteristic features of the polycystic ovary syndrome (PCOS). Androgens are important for bone mass. Studies on bone mineral density (BMD) and fractures in postmenopausal women with PCOS are lacking. The aim of this study was to investigate whether postmenopausal women with PCOS differ from controls regarding body composition, BMD and prevalence of fractures, and to compare women with PCOS with controls regarding correlations between total BMD and sex hormones. DESIGN A prospective 21-year follow-up study. Anthropometry, hormonal measurements and questionnaires were performed in 1987 and in 2008. Fractures were X-ray-verified. BMD measurements were taken in 1992, using single-photon absorptiometry (SPA), and in 2008, using dual-energy X-ray absorptiometry (DXA), to also enable measurements of body composition. PATIENTS Twenty-five women with PCOS (Rotterdam criteria), aged 61-78 years, and 68 randomly allocated age-matched controls. MEASUREMENTS Body composition, BMD, fractures and sex steroids. RESULTS At follow-up, the postmenopausal women with PCOS maintained a higher free androgen index (FAI), but had similar body fat, lean mass and BMD compared with controls. The hip circumference increased only in women with PCOS (P < 0·01), during follow-up. The fracture incidence was similar to that of controls (56% vs 41%, ns). In the controls, total BMD was positively correlated with oestradiol (R = 0·322, P < 0·01) and FAI (R = 0·307, P < 0·05) and negatively correlated with SHBG (R = -0·429, P < 0·001), but not in the women with PCOS. CONCLUSIONS Postmenopausal women with PCOS with persistently higher FAI had similar muscle mass, BMD and fracture incidence as controls during this long-term follow-up.
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Affiliation(s)
- Johanna Schmidt
- Department of Obstetrics and Gynaecology, Section for Endocrinology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Bechtold S, Dalla Pozza R, Putzker S, Roeb J, Buckel M, Weissenbacher C, Schmidt H. Effect of antiandrogen treatment on bone density and bone geometry in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2012; 25:175-80. [PMID: 22260890 DOI: 10.1016/j.jpag.2011.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/23/2011] [Accepted: 11/23/2011] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES To determine the impact of antiandrogen treatment on bone density and geometry. DESIGN Prospective cohort investigation. SETTING Academic research institute. PARTICIPANTS 38 (age 14.96 ± 1.42 yr) subjects with PCOS. INTERVENTIONS Treated with metformin (n = 17) or metformin and antiandrogen (n = 21). MAIN OUTCOME MEASURE Bone density and geometry parameters at baseline and after a mean duration of 1.92 ± 0.88 years using peripheral quantitative computed tomography of the forearm. RESULTS At baseline, z-scores for trabecular (0.53 ± 1.02) and cortical BMD (0.79 ± 1.55) as well as total (0.62 ± 1.07) and medullary cross sectional area (CSA) (0.79 ± 1.29) were elevated. Cortical CSA (-0.01 ± 1.10) and bone strength strain index (SSI) z-scores (-0.01 ± 1.10) were normal. Muscle CSA z-score (0.12 ± 1.70) was normal, but grip strength (-1.60 ± 1.15) was significantly reduced. There were no significant changes within and between the two treatment options in respect to bone density and bone geometry parameters. With antiandrogen treatment, free androgen index (FAI) was significantly lower and grip strength further decreased (P < .001). CONCLUSIONS No significant changes in bone mineral density and geometry parameters took place in PCOS women irrespective of treatment followed over a time of almost two years. General muscle weakness expressed as low grip strength may influence further bone development in PCOS.
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Affiliation(s)
- Susanne Bechtold
- Division of Pediatric Endocrinology, University Children's Hospital, Ludwig-Maximilian University, Munich, Germany.
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Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2011; 97:28-38.e25. [PMID: 22153789 DOI: 10.1016/j.fertnstert.2011.09.024] [Citation(s) in RCA: 1029] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/13/2011] [Indexed: 12/11/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females, with a high prevalence. The etiology of this heterogeneous condition remains obscure, and its phenotype expression varies. Two widely cited previous ESHRE/ASRM sponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008), respectively. The present third PCOS consensus report summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, ethnicity, pregnancy complications, long-term metabolic and cardiovascular health, and finally cancer risk. Additional, comprehensive background information is provided separately in an extended online publication.
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