Determinants of low bone mineral density in premenopausal polycystic ovary syndrome patients

Abstract

Objective: The aim of this study was to evaluate the bone mineral density (BMD) values and to determine the associations between BMD and insulin sensitivity, hyperandrogenemia, body mass index (BMI), and sex hormones in premenopausal polycystic ovary syndrome (PCOS) patients.

Methods: A hundred and three women with PCOS and sixty age- and BMI-matched healthy control women were enrolled to this cross-sectional study. Serum androgen and estradiol (E2) levels were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) and MATSUDA insulin sensitivity index (ISI) were calculated. BMD was measured with a dual X-ray absorptiometer.

Results: Lumbar BMD (LBMD) and femoral neck BMD (FnBMD) values were significantly lower in PCOS group than controls [(p < 0.01) and (p < 0.01)]. In PCOS group, hyperandrogenemic women had higher LBMD and FnBMD values than normoandrogenemic PCOS patients [(p < 0.01) and (p < 0.01)]. In PCOS group, LBMD was significantly correlated with HOMA-IR (r = 0.617; p < 0.01), MATSUDA ISI (r = −0.665; p < 0.01), serum E2 (r = 0.488; p < 0.01), total testosterone (r = 0.436; p < 0.01), and androstenedione (r = 0.337; p < 0.01) levels. Similar correlations observed for FnBMD.

Conclusions: Despite the positive effects of hyperandrogenemia and hyperinsulinemia, PCOS patients have lower bone mineral density due to hypoestrogenism. Insulin resistance, BMI, estrogen, and androgen levels are the determinants of BMD in PCOS.

Chinese abstract

目的：测定绝经多囊卵巢综合征患者骨密度(BMD)值, 明确骨密度值与胰岛素敏感性, 高雄激素血症, 身体质量指数(BMI)和性激素之间的关系。

方法：本研究为一项横断面研究, 涉及实验组103名多囊卵巢综合征患者和对照组的60名符合年龄条件且BMI值正常的健康女性。测定受试者的血清雄激素和雌二醇水平, 并计算其稳态模型-胰岛素抵抗指数(HOMA-IR)和MATSUDA胰岛素敏感性指数(ISI)。骨密度值通过双能X线骨密度仪测定。

结果：研究组女性的腰椎骨密度(LBMD)和股骨颈骨密度(FnBMD)值明显低于对照组女性[(p < 0.01)和(p < 0.01)]。在研究组中, 具有高雄激素血症的女性, 其腰椎骨密度和股骨颈骨密度值均高于雄激素水平正常者[(p < 0.01)和(p < 0.01)]；同时, 稳态模型-胰岛素抵抗指数、MATSUDA胰岛素敏感性指数、血清雌二醇水平、总睾酮值及雄烯二酮水平与腰椎骨密度值呈明显相关[(r = 0.617; p < 0.01), (r = 0.665; p < 0.01), (r = 0.488; p < 0.01), (r = 0.436; p < 0.01)和(r = 0.337; p < 0.01)], 且与股骨颈骨密度值存在相似的相关性。

结论：尽管高雄激素血症和高胰岛素血症可促进骨密度提高, 但多囊卵巢综合征患者仍会因低雌激素血症而造成骨密度降低。胰岛素抵抗, BMI值, 雌激素和雄激素水平均为影响多囊卵巢综合征患者骨密度的关键因素。

Keywords:

• Bone mineral density
• HOMA-IR
• hyperandrogenemia
• MATSUDA
• polycystic ovary syndrome

Declaration of interest

The authors declare that they have no conflict of interest.