Association between pelvic organ prolapse and bone mineral density in postmenopausal women

Abstract

Both pelvic organ prolapse (POP) and osteoporosis are age-related diseases in older aged women. Both POP and bone metabolism may be associated with collagen metabolism. Our study determined the relationship between POP and bone mineral density (BMD) of the lumbar spine and femur neck in postmenopausal women. We selected 554 postmenopausal women (aged 50-79 years) and divided them into two groups (moderate to severe POP and absent to mild POP). We compared the BMDs of the lumbar spine and femur neck between the moderate to severe POP and absent to mild POP groups. Lumbar spine BMD was inversely correlated with POP severity (p = 0.001). However, after adjusting for age, time since menopause, height, weight, body mass index (BMI), and vaginal delivery, the BMDs of both the lumbar spine and femur neck were not significantly different between the moderate to severe POP and absent to mild POP groups (p = 0.583 and p = 0.305, respectively). A lower BMD is associated with increased fracture risk and we postulated that women with severe POP would have an increased risk of osteoporotic fracture.

Pelvic Organ Prolapse Is Associated with Osteoporosis in Korean Women: Analysis of the Health Insurance Review and Assessment Service National Patient Sample

“…The high prevalence of POP and osteoporosis in postmenopausal women raises the possibility that the association is related to low estrogen levels and changes in the amount and quality of collagen and connective tissue [12,16]. Pelvic floor collagen is mainly composed of type I and III collagen, and type I collagen is also the principal component of the organic matrix of the bone [13]. Estrogen acts on collagen, which increases the strength of muscle and connective tissue, and on biochemical molecules that prevent the decomposition of collagen and elastin [23].…”

“…Therefore, the relationship between POP and osteoporosis should be clarified among women of the same race. Among Korean women, Lee et al reported that the BMDs of the lumbar spine and femoral neck were not significantly different between the moderate-to-severe POP group and the no-to-mild POP group among 554 postmenopausal women aged 50-79 years [13]. However, the authors reported that women with severe POP had an increased risk of osteoporotic fractures, suggesting that the severity of POP can affect the relationship between POP and osteoporosis.…”

“…Insufficient collagen amount and changes in the extracellular matrix (ECM) of the pelvic floor are molecular changes that lead to the development of POP [12]. The co-occurrence of hypermobility of the joints, altered pulmonary compliance, and generalized connective tissue disorders include Marfan's and Ehlers-Danlos syndromes, and POP supports this hypothesis [13,14].…”

“…Therefore, considering the similarity in the pathophysiology of two diseases, we hypothesized that there is an association between menopause and an increased risk of POP and osteoporosis. Some studies have identified the relationship between POP and skeletal compromise in postmenopausal women [13][14][15][17][18][19][20]. However, to our knowledge, no large-scale studies have been conducted on the relationship between POP and osteoporosis.…”

Female sexual dysfunction among menopausal women

“…(9) Vaginal pruritus and malodorous discharge [29]. (10) Loss of pelvic muscle tone manifested as prolapse of reproductive or urinary tract organs [30]. (11) Urinary frequency, urgency, and incontinence due to decreased urine pH.…”