Poor Compliance to Hormone Therapy and Decreased Bone Mineral Density in Women with Premature Ovarian Insufficiency

Abstract

Premature ovarian insufficiency leads to through infertility and estrogen deficiency. Optimal management encompasses estrogen replacement therapy. Long-term outcome of women with POI is not known. We design a study to evaluate the medical care, hormone replacement therapy compliance and bone mineral density (BMD) in POI women with at least a five-year follow-up after the first evaluation. One hundred and sixty-two patients (37.3±8.0 years) were evaluated (follow-up 7.9±2.8 years). Sixty-nine patients (42.6%) had stopped their hormone replacement therapy (HRT) for at least one year during the follow up period. BMD determination at initial evaluation and at follow-up visit was completed in 92 patients. At first evaluation, 28 patients (30%) had osteopenia and 7 (8%) had osteoporosis. At follow up, 31 women (34%) had BMD impairment with osteopenia in 61% and osteoporosis in 5%. In univariate analysis and multivariate analysis, there was a significant loss of femoral BMD in women who had stopped their HRT for over a year. In conclusion, this first study concerning long-term follow-up of POI patients shows the poor compliance to their HRT, despite its importance in the prevention of bone demineralization. This study reinforces the need for follow up and specific care for POI women.

Premature ovarian insufficiency: an International Menopause Society White Paper

“…Osteoporosis is a key concern for women with POI 43,44 , with estimated prevalence rates ranging from 8% to 27% according to the definition used (BMD or fracture) and the cause of POI 12,[103][104][105] . Women with POI have significantly lower BMD 105,106 and an increased risk of osteoporosis compared to women with usual age at menopause (odds ratio 2.54; 95% CI 1.63-3.96) 12 , especially in women younger than 70 years 12,105 .…”

“…Identified risk factors for low BMD incorporate both generally recognized and cause-specific factors and, in women with spontaneous normal karyotype POI, include age <20 years at onset of irregular menses, >1 year delay in diagnosis, low serum vitamin D concentrations, low dietary calcium, non-compliance with HT, and lack of exercise 103,106 . Women with Turner syndrome may have additional contributors to bone loss including genetically related skeletal fragility, increased risk of celiac disease, and increased risk of falls secondary to hearing loss and visuospatial abnormalities 107 .…”

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“…В ходе проведённого исследования было выявлено, что возраст достоверно является одним из очень важных признаков, влияющих отрицательно на плотность костной ткани, что подтверждается и многими другими исследованиями, в том числе и по данным компьютерной томографии [11]. Вторым не менее важным фактором, снижающим плотность костной ткани, является дефицит половых гормонов [12]. В связи с комбинацией этих причин снижение плотности костной ткани отчетливо и достоверно проявилось по данным наших исследований стенок верхнечелюстного синуса в период менопаузы (р < 0,05) в первой исследуемой группе женщин 50 и старше лет с ИМТ 18,5-24,9 кг/м 2 по сравнению с контрольной группой.…”

Premature ovarian insufficiency – hormone replacement therapy and management of long-term consequences

“…Sex steroid replacement therapy restores bone density in young patients with ovarian function depletion [ 3 ]. The results of the study by Bachelot et al revealed significant reduction in femur BMD and an increased incidence of osteopaenia and osteoporosis in the group of women with POI, who discontinued HRT after one year of treatment, compared to women who continued it for at least five years [ 8 ]. Treatment with transdermal oestradiol and vaginal progesterone has a more beneficial effect on the bone mass in the lumbar spine than standard HTM [ 9 ].…”

“…However, the compliance among the POI patients is low. Around 40% of POI patients discontinue the therapy within the first year of treatment [ 8 , 9 ]. The patient’s preferences for optimal route, drug, and type of hormonal therapy should be key in the choice of treatment.…”