Factors of mineral homeostasis impairment and bone mineral density loss in women with central hypogonadism

Abstract

Objective

The aims of the study were to estimate markers of mineral turnover and bone mineral density (BMD) in young women with central hypogonadism (CH) in comparison with healthy young and postmenopausal women, and to reveal the possible impact of different factors on BMD.

Method

We examined 73 patients with CH (mean age 25 [21.2; 30.5] years, mean duration of amenorrhea 5 [2.3; 10.1] years), 47 young healthy women (mean age 24 [23.1; 28.0] years) and 50 healthy women in natural postmenopause (mean age 56 [53; 58] years, mean duration of 6 [2; 10] years since last menstrual period). Women with CH were examined before and after 12 months of treatment with 17β-estradiol 2 mg and dydrogesterone 10 mg in continuous sequential fashion.

Results

Levels of calcium, alkaline phosphatase, and C-terminal telopeptide of type I collagen were statistically higher in women with CH without treatment than in young healthy women but did not differ from those in postmenopausal women. Prevalence of T-score ≤−2.5 standard deviations was higher in CH than in postmenopause both in lumbar vertebrae and total femur. Factors that were responsible for lower BMD in young women with CH included the duration of hypoestrogenism, primary amenorrhea, and hypoandrogenism.

Conclusion

Central hypogonadism at a young age poses a higher risk of bone metabolism impairment than physiological menopause.

摘要

目的：该研究的目的是评估与健康的年轻女性和绝经后女性相比, 患有中枢性性腺功能减退症（CH）的年轻女性的矿物质转换和骨密度（BMD）的指标变化, 并揭示不同因素对BMD的可能影响。方法：我们检查了73名CH患者（平均年龄25 [21.2; 30.5]岁, 平均闭经持续时间5 [2.3; 10.1]年）, 47名年轻健康女性（平均年龄24 [23.1; 28.0]岁）和50名自然绝经后的健康女性（平均年龄56 [53; 58]岁, 平均自上一次月经后持续6 [2; 10]年）。在使用12个月 2 mg 17β-雌二醇和10 mg 地屈孕酮连续序贯方案治疗前后, 对患有CH的女性进行了检查。结果：未经治疗的CH女性的钙, 碱性磷酸酶和I型胶原C末端肽水平在统计学上高于年轻健康女性, 但与绝经后女性相比没有差异。CH患者腰椎和股骨中T值≤2.5标准差的患病率均高于绝经后女性的患病率。导致年轻女性CH患者BMD降低的因素包括低雌激素持续时间, 原发性闭经和雄激素过多。结论：年轻的中枢性性腺功能减退症比生理上的更年期带来更高的骨代谢损害风险。

Keywords:

• Mineral turnover
• bone mineral density
• central female hypogonadism
• hypopituitarism
• Z-score
• T-score

Potential conflict of interest

Ilovayskaya has received lecture fees from Abbott, Bayer, Pfizer, Ipsen and Novartis. The other authors have no conflict of interest to declare.

Source of funding

Nil.

Notes

1 In the case of primary amenorrhea, the duration of CH was considered as the period from the age of 13 years (average menarche age) until the moment of investigation