Competing Factors Link to Bone Health in Polycystic Ovary Syndrome: Chronic Low-Grade Inflammation Takes a Toll

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.

Assessing C reactive protein/albumin ratio as a new biomarker for polycystic ovary syndrome: a case–control study of women from Bahraini medical clinics

“…Small sample sizes, heterogeneous populations and an inability to correct for confounding factors, such as BMI and use of oral contraceptives, both of which influence inflammatory markers such as CRP, 21 has in part hampered efforts in assigning inflammation as truly a defining feature of PCOS. This current analysis has overcome some of the main issues in assessing the independent relationship between PCOS and chronic low-grade inflammation.…”

“… 20 It was subsequently used to show the influence of chronic subclinical inflammation on bone quality in women with PCOS. 21 Although CRP is used to predict cardiovascular risk and is associated with metabolic disorders associated with obesity and IR, 28–31 it has been criticised for being too general and non-specific a marker for inflammation. 32 …”

“… 20 CRP/albumin ratio was also found to be significantly higher in premenopausal women with PCOS relative to controls, and adversely predicted their bone quality. 21 Given the ability of CRP/albumin to simultaneously capture chronic inflammation and metabolic dysfunction in premenopausal women, we hypothesised that CRP/albumin ratio may serve as a strong predictor of PCOS in a cohort of similarly aged women. This case–control study investigated CRP/albumin ratio along with classical markers, androgen excess and IR, in their association with PCOS in 319 premenopausal Bahraini Arab women.…”

The association of female and male infertility with telomere length (Review)

“…Several studies have thoroughly investigated the association of female infertility with TL. The majority of studies exploring the association between female infertility factors and TL are outlined in Table I and have revealed a positive association, while only 3 have revealed negative association (36-38). Of the 21 positively associated studies, 11 studies demonstrated a shorter TL, while 10 demonstrated a longer TL.…”

Telomere length and telomerase activity during folliculogenesis in mammals

“…It is important to note that, in order to determine the precise impact of the histopathological/hormonal changes on telomere length, telomeres should be measured in the granulosa cells of PCOS patients. In recent studies, telomere lengths were measured by qPCR in the leukocytes obtained from either PCOS patients or control subjects and no remarkable differences were detected [93,94,95]. However, the length of telomeres in the granulosa cells was found to be significantly longer in the PCOS group (1.57 ± 0.67) than in the controls (1.00 ± 0.37) [93] (Table 1…”