Spinal Bone Loss and Ovulatory Disturbances

Prior, Jerilynn C.; Vigna, Yvette M.; Schechter, Martin T.; Burgess, Arthur E.

doi:10.1056/nejm199011013231801

Cited by 437 publications

(137 citation statements)

References 27 publications

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“…In this regard, the role of progesterone seems to be important [11, 12]. Furthermore, the elevated circulating insulin levels often associated with PCOS may influence the osteoblast cells activity through direct stimulation or indirectly by reducing production of the sex hormone binding globulin (SHBG) and insulin-like growth factor binding protein (IGFBP) [6, 13].…”

Section: Introductionmentioning

confidence: 99%

Bone mineral density in women with polycystic ovary syndrome

Kołodziejczyk

Sławek

Czyźyk

et al. 2014

J Endocrinol Invest

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PurposePCOS 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.Methods69 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).ResultsThe PCOS women had lower BMD values as compared to the controls (1.057 ± 0.1260 vs. 1.210 ± 0.1805 g/cm2, 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.ConclusionsThe 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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Section: Introductionmentioning

confidence: 99%

Bone mineral density in women with polycystic ovary syndrome

Kołodziejczyk

Sławek

Czyźyk

et al. 2014

J Endocrinol Invest

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“…Early menopause (before age 45 years), both natural and surgically induced, leads to an increased risk of mortality and fragility fractures [21] because these women are exposed to a hypogonadal state for a longer time [3] . Similarly, many abnormalities of menstrual function as well as late menarche and primary or secondary amenorrhea might also contribute to low BMD and therefore also increase the risk of osteoporosis [3,22,23] . Hypogonadism also occurs in a small proportion of men and might led to bone loss [24] and fractures [25] .…”

Section: Assessment Of Crfsmentioning

confidence: 99%

Major osteoporotic fragility fractures: Risk factor updates and societal impact

Pisani¹,

Renna²,

Conversano³

et al. 2016

WJO

402

243

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Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders (for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence.

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“…For example, BMD is reportedly normal, decreased or increased in young women with ovarian hyperandrogenism, an entity characterized by androgen overproduction and relatively high serum levels of estrogens [15, 16, 37]. The apparent discrepancies between those study results may be due to the interference of factors such as obesity, hyperinsulinemia, and failing progesterone secretion, each of which are common in these women and may alter the effects of sex steroids on bone metabolism [14, 15, 37, 38]. …”

Section: Discussionmentioning

confidence: 57%

Increased Bone Mineral Density and Serum Leptin in Non-Obese Girls with Precocious Pubarche: Relation to Low Birthweight and Hyperinsulinism

et al. 2000

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Background: Hyperinsulinism and hyperandrogenism have the capacity to increase bone mineral density (BMD) and serum leptin, independently of body fat mass. We therefore assessed lumbar BMD and serum leptin in girls with the sequence of a low birthweight and precocious pubarche (PP) in childhood, in whom hyperinsulinism and hyperandrogenism have been described. Methods: Fifty-two non-obese PP girls were studied (age range 6.9–14.9 years). Serum leptin was also measured in 42 control girls, matched for age, body mass index and pubertal stage. Results: BMD SDS, measured by dual-energy X-ray absorptiometry, was elevated in PP girls compared to the population reference (0.39 ± 0.18 SDS; p = 0.03) and bone age, assessed from hand radiographs, was significantly advanced compared to chronological age (1.2 ± 0.1 years; p < 0.0005). Conclusion: Compared to control girls, PP girls had higher leptin levels for degree of body mass index (PP girls: 9.4 ± 0.6 ng/ml; controls: 7.8 ± 0.6 ng/ml; p = 0.01). In PP girls, serum leptin was inversely related to birthweight (r = –0.32, p = 0.01) and positively related to free androgen index (FAI) (r = 0.71, p < 0.0005). BMD SDS was also inversely related to birthweight (r = –0.26, p < 0.05) and positively related to serum leptin (r = 0.42, p < 0.05), FAI (r = 0.45, p < 0.05) and mean serum insulin during oral glucose tolerance testing (MSI) (r = 0.59, p < 0.0005). In multiple regression, MSI was the strongest determinant of BMD SDS (β = 0.50, p = 0.002). In conclusion, elevated BMD and serum leptin in non-obese PP girls were related to degrees of low birthweight, hyperinsulinism and hyperandrogenism. The characteristic hyperinsulinism of PP girls is proposed to be the key variable in this constellation.

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Spinal Bone Loss and Ovulatory Disturbances

Abstract: Decreases in spinal bone density among women with differing exercise habits correlated with asymptomatic disturbances of ovulation (without amenorrhea) and not with physical activity.

Cited by 437 publications

References 27 publications

Bone mineral density in women with polycystic ovary syndrome

Bone mineral density in women with polycystic ovary syndrome

Major osteoporotic fragility fractures: Risk factor updates and societal impact

Increased Bone Mineral Density and Serum Leptin in Non-Obese Girls with Precocious Pubarche: Relation to Low Birthweight and Hyperinsulinism

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