Bone mineral density and vitamin D in PCOS and hirsutism

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.

Keywords::

• BMD
• insulin
• metformin
• testosterone
• vitamin D

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Polycystic ovary syndrome (PCOS) is associated with unchanged or increased bone mineral density (BMD), which is associated with central obesity, insulin resistance, hyperandrogenemia and increased estrogen levels.

• • Patients with PCOS may have increased peak bone mass, but more data are needed.

• • Fracture risk and BMD levels in postmenopausal patients with PCOS remain to be established.

• • Medical treatment with oral contraceptives and metformin seem to have no adverse effects on BMD, but data on bone mineral turnover are lacking.

• • Low vitamin D levels in PCOS are associated with obesity, hirsutism and insulin resistance.

• • Vitamin D substitution is recommended in obese patients with PCOS and in patients avoiding sun exposure. There are no data to support general vitamin D substitution in hirsutism and PCOS.

Notes