Pelvic Organ Prolapse and Relationship with Skeletal Integrity

Objectives To characterize the association between thoracic (T) and lumbar (L) spinal curvature and pelvic floor (PF) symptoms (pelvic organ prolapse [POP], urinary incontinence [UI], fecal incontinence [FI]). Methods Of women undergoing a bone mineral density scan from 1/2007 to 10/2010, patients who completed PF symptom questionnaires and had T and/or L spine radiographs or computerized tomography (CT) exams within 3 years of questionnaire completion were included in this study. The spine angles were measured using the Cobb angle method. The T and L curvature were categorized as hypo-kyphosis (<20°), normal thoracic kyphosis (20–40°), hyper-kyphosis (>40°), hypo-lordosis (<40°), normal lumbar lordosis (40–70°), and hyper-lordosis (>70°). The presence and type of UI were identified with the 3 Incontinence Questionnaire and FI with the Modified Manchester Questionnaire. POP was defined as a positive response to the presence of a bulge question from the PF Distress Inventory-20. Results Of 1665 eligible women, 824 and 302 (mean age 64±10 for both) had T and L spine images, respectively. No differences in PF symptoms were observed in the T or L spine groups categorized by hypo-, normal, and hyper-kyphosis/lordosis except for urgency UI being more prevalent in the hypo-lordosis group (p=0.01). However, upon further characterization using logistic regression, no association was noted between PF symptoms and T or L spine angles; no differences in the mean angles were found between women with versus without PF symptoms (p≥0.05). Conclusions The current study shows that the thoracic and lumbar spinal curvature is not associated with the presence of pelvic floor symptoms.

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“…[1,10–14] A correlation has been shown between skeletal fragility and POP in postmenopausal women. [15,16]…”

Section: Introductionmentioning

confidence: 99%

Pelvic Floor Symptoms and Spinal Curvature in Women

Meyer

McArthur

Tang³

et al. 2016

Female Pelvic Med Reconstr Surg

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“…Knowledge about additional risk factors for reduced bone mineral density (BMD) may further improve the identification of individuals at increased risk of fractures. Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), urinary incontinence and anal incontinence, are common conditions in women, and it has been hypothesized that PFDs and low BMD may represent manifestations of a generalized disturbance in collagen metabolism [7]. Based on this hypothesis, previous studies have investigated the association between PFDs and reduced bone quantity or quality [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), urinary incontinence and anal incontinence, are common conditions in women, and it has been hypothesized that PFDs and low BMD may represent manifestations of a generalized disturbance in collagen metabolism [7]. Based on this hypothesis, previous studies have investigated the association between PFDs and reduced bone quantity or quality [7][8][9][10][11][12]. However, these studies provided conflicting results, and often included participants undergoing osteoporotic evaluation in a clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Association between pelvic floor disorders and bone mineral density: Findings from the HUNT study

Aspli

Vikjord

Horn

2022

European Journal of Obstetrics & Gynecology and Reproductiv

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To examine the association between pelvic floor disorders (pelvic organ prolapse, urinary incontinence and anal incontinence) and bone mineral density (BMD). Study design: A cross-sectional study of 6809 women who participated in the third survey of the population-based Norwegian HUNT study was undertaken. BMD was measured by dual-energy X-ray absorptiometry. Information on BMD and self-reported pelvic floor disorders from the HUNT study was linked with hospital-derived data on diagnosis and surgical treatment of pelvic floor disorders. BMD was categorized according to the World Health Organization criteria (normal, osteopenia and osteoporosis). Multi-variate logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for the association between pelvic floor disorders and BMD. Results: Women with a hospital diagnosis of stress urinary incontinence (SUI) were less likely to have osteopenia (OR 0.66, 95% CI 0.50-0.87) or osteoporosis (OR 0.66, 95% CI 0.34-1.30) compared with women without a diagnosis of SUI. In women with self-reported information on pelvic floor disorders, women with a history of SUI had lower odds for osteopenia (OR 0.88, 95% CI 0.75-1.02) or osteoporosis (OR 0.69, 95% CI 0.46-1.01), while no association was found between anal incontinence, self-reported surgery for pelvic organ prolapse, and osteopenia or osteoporosis. Conclusion: Pelvic organ prolapse was not associated with BMD. The reasons underlying the observed association between SUI and BMD require further investigation.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Lee

Kim

et al. 2021

JCM

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Background and Objectives: Pelvic organ prolapse (POP) and osteoporosis are major disease entities in older women that have the same epidemiology and might also have the same molecular physiology. However, few data have been reported on the relationship between POP and osteoporosis. We designed this study to examine the association between POP and osteoporosis in Korean women. Materials and Methods: We used the Health Insurance Review and Assessment Service 2015 to 2017 National Patient Sample (HIRA-NPS). A total of 4,368,141 individuals were included in this study, and a total of 842,228 individuals aged 50 years and above were included in the final analysis. POP patients were defined by the Korean Informative Classification of Diseases (KOICD) codes (KCD-7, N81, or N99.3) and patients who underwent a pelvic reconstructive procedure. The osteoporosis patients were defined by KOICD (KCD-7, R4113, R3620, R0402,) who were prescribed osteoporosis medication. A 1:10 age-stratified matching and chi-squared test were used for statistical analysis, and p < 0.05 was considered as significant. Results: A total of 7359 women were included in this analysis. Advanced POP was correlated with osteoporosis in Korean women aged 50 years and above in 2015–2017 (p < 0.0001). After adjusting for age, advanced POP was correlated with osteoporosis in the 2015, 2016, and 2017 dataset (p = 0.013, 0.0009, 0.0119, respectively). Conclusions: Advanced POP is correlated with osteoporosis in Korean women aged 50 years and above. Evaluation for osteoporosis and education about bone health can be especially important, even in relatively young women, aged 50–59 years, and POP patients.

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Pelvic Organ Prolapse and Relationship with Skeletal Integrity

Cited by 7 publications

References 45 publications

Pelvic Floor Symptoms and Spinal Curvature in Women

Pelvic Floor Symptoms and Spinal Curvature in Women

Association between pelvic floor disorders and bone mineral density: Findings from the HUNT study

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

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