“…BMD is a major determinant of bone strength, but fragility fractures can occur also in women with normal or slightly reduced BMD as observed in the general population [ 109 ]. In PCOS women, some studies reported lower BMD values [ 111 , 112 , 113 , 114 , 115 ], while others reported no difference in BMD in comparison with healthy controls [ 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 ], probably due to differences in selection criteria and age of participants. A systematic review and meta-analysis showed that, in comparison with controls, women with PCOS and BMI < 27 kg/m², but not women with PCOS with BMI ≥ 27 kg/m², have decreased spinal and femur BMD, suggesting a role for adiposity in contributing to bone parameters [ 66 ].…”