Management of bone health in women with premature ovarian insufficiency: Systematic appraisal of clinical practice guidelines and algorithm development

Kiriakova, Velislava; Yeganeh, Ladan; Somarajah, Gowri; Milat, Frances; Vincent, Amanda

doi:10.1016/j.maturitas.2019.07.021

Cited by 15 publications

(19 citation statements)

References 45 publications

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“…None of the included studies controlled for growth hormone, and only one study controlled for height 17 . In the literature, HT is recommended for women with TS due to cardiovascular benefits, such as a moderate increase in blood pressure due to a reduction in the renin-angiotensin system, compared with OCP 1,7 . Women with TS often have many comorbidities including cardiovascular anomalies, and therefore it is important to consider a hormone therapy formulation that does not substantially increase adverse health outcomes 9 …”

Section: Discussionmentioning

confidence: 99%

“…17 In the literature, HT is recommended for women with TS due to cardiovascular benefits, such as a moderate increase in blood pressure due to a reduction in the renin-angiotensin system, compared with OCP. 1,7 Women with TS often have many comorbidities including cardiovascular anomalies, and therefore it is important to consider a hormone therapy formulation that does not substantially increase adverse health outcomes. 9 In this systematic review, increases in lumbar spine BMD in response to OCP and HT were consistently reported across studies.…”

Section: Hormone Therapy Versus Ocpmentioning

confidence: 99%

“…8 A 2019 systematic appraisal of clinical practice guidelines reported that most clinical guidelines regarding bone health in POI are of average to poor quality. 7 Furthermore, even high-quality guidelines have recommendation gaps and limitations in evidence with respect to bone health in POI, 7 indicating the need for further research in this area. It should be noted that very few studies have examined the impact of OCP or HT versus placebo in the context of bone health in POI.…”

Section: Fine Et Almentioning

confidence: 99%

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Comparing estrogen-based hormonal contraceptives and hormone therapy on bone mineral density in women with premature ovarian insufficiency: a systematic review

et al. 2022

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Importance:Premature ovarian insufficiency (POI) is a condition associated with estrogen deficiency which leads to decreased bone mineral density and an increased risk of osteoporosis and fractures. Estrogen-based hormone therapy is an integral component of treatment; however, to date the ideal hormone formulation for optimizing bone health has not been established.Objective:To assess the effects of estrogen-based oral contraceptives (OCP) versus hormone therapy (HT) on bone mineral density (BMD) in women with POI.Evidence Review:A systematic review of Ovid MEDLINE, EMBASE, Cochrane Library, and Web of Science databases was conducted from conception until December 2020. Randomized controlled trials (RCTs) and observational studies that met inclusion criteria were included in the analysis. Risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale for cohort studies and the Cochrane Risk of Bias for RCTs. The study protocol was registered with the International Prospective Register of Systematic Reviews and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.Findings:Our search yielded 1,227 studies; 3 RCTs and 2 observational cohort studies met inclusion criteria and were included in our study. The largest subpopulation was Turner Syndrome (n = 625), followed by idiopathic POI (n = 146). Of the four studies that assessed changes in BMD, two studies reported a significant increase in lumbar spine BMD with HT compared with OCP (+0.050 g/cm2, P < 0.025; +0.019 g/cm2, P < 0.01), one study found similar improvement in lumbar spine BMD across treatments (HT −0.003 g/cm2, P = 0.824), and one study did not directly compare treatments. Effects on bone turnover markers were inconsistent across three studies that evaluated this outcome.Conclusions and Relevance:This is the first systematic review to include studies that directly compared OCP and HT on bone outcomes in POI. While two studies reported increased lumbar spine BMD with HT, this result was not consistently found across studies. There were important differences in POI etiology, treatment regimens and formulations, and risk of bias was high in many of the studies. These results indicate future, larger-scale trials are needed to further understand the optimal hormone therapy for bone density in POI.

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Section: Discussionmentioning

confidence: 99%

Section: Hormone Therapy Versus Ocpmentioning

confidence: 99%

Section: Fine Et Almentioning

confidence: 99%

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Comparing estrogen-based hormonal contraceptives and hormone therapy on bone mineral density in women with premature ovarian insufficiency: a systematic review

et al. 2022

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“…A systematic appraisal of clinical guidelines for management of bone health in women with POI revealed variable quality and a paucity of high-quality evidence to guide management 116 . All guidelines agreed that HT should be initiated and continued until at least the age of usual menopause, but variation occurred in regard to screening and monitoring, with no consensus regarding the optimum HT.…”

Section: Bone Health In Women With Premature Ovarian Insufficiencymentioning

confidence: 99%

Premature ovarian insufficiency: an International Menopause Society White Paper

et al. 2020

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The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.

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“…Assessment of fracture risk in POI is challenging and requires comprehensive evaluation. The key aspects can be divided into the assessment of (1) general risk factors including modifiable and nonmodifiable risk factors, (2) specific POI risk factors consisting of degree and duration of hypoestrogenemia and associated comorbidities, 99 and (3) bone assessment through the use of various imaging modalities (►Fig. 1).…”

Section: Risk Factor Evaluationmentioning

confidence: 99%

Musculoskeletal Health in Premature Ovarian Insufficiency. Part Two: Bone

et al. 2020

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Accelerated bone loss and muscle loss coexist in women with premature ovarian insufficiency (POI), but there are significant gaps in our understanding of musculoskeletal health in POI. This review describes estrogen signaling in bone and its role in skeletal health and disease. Possible mechanisms contributing to bone loss in different forms of POI and current evidence regarding the utility of available diagnostic tests and therapeutic options are also discussed. A literature review from January 2000 to March 2020 was conducted to identify relevant studies. Women with POI experience significant deterioration in musculoskeletal health due to the loss of protective effects of estrogen. In bone, loss of bone mineral density (BMD) and compromised bone quality result in increased fracture risk; however, tools to assess bone quality such as trabecular bone score (TBS) need to be validated in this population. Timely initiation of HRT is recommended to minimize the deleterious effects of estrogen deficiency on bone in the absence of contraindications; however, the ideal estrogen replacement regimen remains unknown. POI is associated with compromised bone health, regardless of the etiology. Ongoing research is warranted to refine our management strategies to preserve bone health in women with POI.

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Management of bone health in women with premature ovarian insufficiency: Systematic appraisal of clinical practice guidelines and algorithm development

Cited by 15 publications

References 45 publications

Comparing estrogen-based hormonal contraceptives and hormone therapy on bone mineral density in women with premature ovarian insufficiency: a systematic review

Comparing estrogen-based hormonal contraceptives and hormone therapy on bone mineral density in women with premature ovarian insufficiency: a systematic review

Premature ovarian insufficiency: an International Menopause Society White Paper

Musculoskeletal Health in Premature Ovarian Insufficiency. Part Two: Bone

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