Menstrual history as a determinant of current bone density in young hirsute women

Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with features including hyperandrogenism and menstrual irregularity frequently treated with hormonal steroidal contraceptives. Women with PCOS appear to have lower bone mineral density (BMD). While steroidal contraceptives may positively affect bone health, their effect on BMD in PCOS is not known. The aim of this study was to assess BMD in women with PCOS according to recent contraceptive use. A cross-sectional analysis of 95 pre-menopausal overweight or obese sedentary women with PCOS [age 29.4 ± 6.4 years, body mass index (BMI) 36.1 ± 5.3 kg/m(2)] who either recently took steroidal contraceptives (ceased 3 months prior) or were not taking steroidal contraceptives was conducted. Clinical outcomes included BMD, anthropometry, insulin, glucose, reproductive hormones, dietary intake and vitamin use. BMD was significantly lower for women who used contraceptives compared to those who did not (mean difference 0.06 g/cm(2) 95 % confidence interval -0.11, -0.02, p = 0.005). In regression models, lower BMD was independently associated with contraceptive use (β = -0.05, 95 % CI -0.094, -0.002, p = 0.042), higher testosterone (β = -0.03, 95 % CI -0.05, -0.0008, p = 0.043) and lower BMI (β = 0.006, 95 % CI 0.002, 0.01, p = 0.007) (r (2) = 0.22, p = 0.001 for entire model). We report for the first time that overweight and obese women with PCOS with recent steroidal contraceptive use had lower BMD in comparison to non-users independent of factors known to contribute to BMD. Whether this observation is directly related to steroidal contraceptive use or other factors requires further investigation.

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“…This is supported by hirsute oligo or amenorrheic women having lower BMD and summed estradiol levels than hirsute eumenorrheic women [12].…”

Section: Discussionmentioning

confidence: 86%

Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome

et al. 2015

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“…It is well known that amenorrheic women have lower lumbar-spine bone density than do eumenorrheic controls (26). Recently, Devleta and colleagues (27) found that BMD was lower in hypergonadotropic amenorrheic women with high circulating FSH, compared with in amenorrheic females with normal or low FSH levels, reinforcing the hypothesis that greater bone loss in the hypergonadotropic amenorrheic group may have been caused by a potential direct effect of FSH on bone metabolism.…”

Section: Discussionmentioning

confidence: 89%

Follicle-stimulating hormone does not directly regulate bone mass in human beings: evidence from nature

Castelo-Branco

León²,

Durán

et al. 2008

Fertility and Sterility

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“…Studies in adults have demonstrated increased BMD in hirsute women with and without polycystic ovarian syndrome compared with nonhirsute women. High androstenedione is a frequent finding in hirsute women, but correlations between BMD or BMC and androstenedione have been inconsistently demonstrated (15,16). In a study of two prepubertal and eight pubertal girls with complete androgen insensitivity syndrome, BMD was significantly lower than that of controls (17), suggesting a role for androgens in bone mineral accrual.…”

Section: Discussionmentioning

confidence: 97%

“…High androstenedione is a frequent finding in hirsute women, but correlations between BMD or BMC and androstenedione have been inconsistently demonstrated (15,16). In a study of two prepubertal and eight pubertal girls with complete androgen insensitivity syndrome, BMD was significantly lower than that of controls (17), suggesting a role for androgens in bone In vitro studies have demonstrated that bone has AR that are responsive to the adrenal androgen dehydroepiandrosterone (DHEA), although to a lesser degree than to the gonadal androgen dihydrotestosterone (DHT) (31,32).…”

Section: Discussionmentioning

confidence: 99%

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Prepubertal Girls with Premature Adrenarche Have Greater Bone Mineral Content and Density Than Controls

Sopher

Thornton

Silfen

et al. 2001

The Journal of Clinical Endocrinology & Metabolism

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Body composition in premature adrenarche (PA) has not been described. We hypothesized that the increased adrenal androgens in PA would have a trophic effect on lean body components. We studied 14 PA subjects and 16 controls, all pre-pubertal Hispanic girls. The body composition parameters tested included height, weight, bone mineral density (BMD), bone mineral content (BMC), nonbone fat-free mass, total body potassium, total body water, and extracellular water. Bone age was determined in all PA subjects.Compared with controls, PA subjects had significantly higher BMC (P = 0.02) and BMD (P = 0.03) when adjusted for age, weight, height, and fat mass, but were not different in the following lean body components: fat-free mass, total body potassium, total body water, and extracellular water. There was no difference in BMD or BMC between the PA subjects with and without advanced bone age.These data suggest a specific effect of PA on bone mineral, but not on other lean body components. The absence of a correlation between bone age and bone mineral in this small group leads us to propose there are separate promoters of bone age advancement and bone mineral accrual. Candidate hormones for these processes include adrenal androgens, E, and IGF-I. The findings of this study suggest that hormonal alterations associated with PA affect bone mineral accrual and may elucidate the mechanisms involved in this process.Precocious or premature pubarche is defined as the appearance of pubic hair before 8 yr in girls and 9 yr in boys unaccompanied by signs of true puberty, such as breast development in girls and testicular enlargement in boys. Premature adrenarche (PA) is the term used for individuals with premature pubarche whose adrenal androgens are at the Tanner stage 2 level of puberty and in whom enzymatic defects of steroidogenesis, precocious puberty, and adrenal or gonadal malignancy have been ruled out (1, 2). PA is caused by an early isolated maturation of the zona reticularis of the adrenal cortex resulting in increased adrenal androgen secretion for chronological age (3-6). However, some individuals with PA have normal androgen levels but increased peripheral sensitivity to androgens (7). Tall stature and advanced skeletal maturation may be present at diagnosis (4,5,8). Although PA was originally thought to be a benign and self-limited physiological process, recent work suggests that girls with PA are more likely to develop polycystic ovary syndrome, hyperinsulinism, and dyslipidemia (9-13). HHS Public AccessRecently, there have been numerous studies that describe the effects of androgens and estrogens (E) on lean body components (14-23). Components of the lean body mass that are positively affected by androgens include bone, nonbone fat-free mass, total body potassium, and total body water. Evaluation of body composition in girls with PA may suggest mechanisms responsible for bone mineral and lean body mass accrual. To our knowledge the effects of relative hyperandrogenism on lean body mass components in prepube...

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Menstrual history as a determinant of current bone density in young hirsute women

Cited by 18 publications

References 15 publications

Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome

Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome

Follicle-stimulating hormone does not directly regulate bone mass in human beings: evidence from nature

Prepubertal Girls with Premature Adrenarche Have Greater Bone Mineral Content and Density Than Controls

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