Effects of distinct Polycystic Ovary Syndrome phenotypes on bone health

Abstract

Polycystic Ovary Syndrome (PCOS) is a highly prevalent and heterogenous endocrinopathy affecting 5-18% of women. Although its cardinal features include androgen excess, ovulatory dysfunction, and/or polycystic ovarian morphology, women often display related metabolic manifestations, including hyperinsulinaemia, insulin resistance, and obesity. Emerging data reveal that the hormonal alterations associated with PCOS also impact bone metabolism. However, inconsistent evidence exists as to whether PCOS is a bone-protective or bone-hindering disorder with an accumulating body of clinical data indicating that hyperandrogenism, hyperinsulinaemia, insulin resistance, and obesity may have a relative protective influence on bone, whereas chronic low-grade inflammation and vitamin D deficiency may adversely affect bone health. Herein, we provide a comprehensive assessment of the endocrine and metabolic manifestations associated with PCOS and their relative effects on bone metabolism. We focus principally on clinical studies in women investigating their contribution to the alterations in bone turnover markers, bone mineral density, and ultimately fracture risk in PCOS. A thorough understanding in this regard will indicate whether women with PCOS require enhanced surveillance of bone health in routine clinical practice.

Prevalence and Diagnosis of PCOS Using Electronic Health Records: A Scoping Review and a Database Analysis

“…Despite the variety of criteria available, there is no agreement on the most suitable or precise criteria for diagnosing PCOS. Additionally, different criteria may lead to the identification of distinct subgroups of women with PCOS [ 7 ], complicating the use of EHRs in identifying the condition in large epidemiological studies.…”

Altered Vitamin D Status and Bone Mineral Density in Obese and Non-obese Patients With Polycystic Ovary Syndrome: A Cross-Sectional Study in Turkey

“…Hyperandrogenemia, high estrogen concentration, hyperinsulinemia, and a tendency to increase body mass index (BMI) help protect PCOS patients from osteoporosis, and the propensity to fractures decreases [5]. In previous studies, hyperandrogenemia, seen in approximately 75% of patients with PCOS, has been shown to positively affect bone by connecting to bone-related androgen receptors or indirectly by converting to estrogen through peripheral aromatization [6].…”

“…This released molecule also has a resorptionincreasing effect on osteoclasts. These hormones trigger osteoblast transformation and increase extracellular matrix production and mineralization [5]. Although these hormones positively impact bone individually, their effects on bone in the impaired hormonal and metabolic environment in PCOS are controversial.…”

“…Although these hormones positively impact bone individually, their effects on bone in the impaired hormonal and metabolic environment in PCOS are controversial. In addition, VDD, long-lasting amenorrhea, hypercortisolemia resulting from hyperactivation of the hypothalamic-pituitary-adrenal axis, and impaired growth hormone secretion may negatively affect bone in PCOS patients [5].…”