POLYCYSTIC OVARY SYNDROME AND BONE TURNOVER IN POSTMENOPAUSAL WOMEN

Abstract

Considering the metabolic and hormonal changes associated with polycystic ovary syndrome (PCOS), their potential affect bone health has been proposed. The aim of the current study was to evaluate the effect of several hormonal and metabolic alterations associated with polycystic ovary syndrome on bone in postmenopausal women.

Materials and methods: The study included 56 patients with PCOS and 42 women without this disease aged 50–65 years. Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD) of the lumbar spine and femoral neck. Serum levels of amino-terminal propeptide of procollagen 1 (P1NP) and carboxy-terminal telopeptide of type I collagen (b-CTx), as well as levels of parathyroid hormone (PTH), vitamin D (25(OH)D₃), anti-Mullerian hormone (AMH), insulin, testosterone (T), 17-hydroxyprogesterone (17-OHP), dehydroepiandrostenedione sulfate (DHEAS), follicle stimulating hormone, luteinizing hormone, and estradiol were determined. The HOMA-IR index and anthropometric indicators were calculated.

Statistical data were analyzed by nonparametric testing using BioStat Pro 6.2.2.0 software (AnalystSoft Inc., Walnut, USA). Quantitative data are presented as median and quartiles 1 and 3 (Me [Q1; Q3]); The significance of intergroup differences was established using the Mann–Whitney U test (p<0.05). To identify relationships between indicators, a univariate analysis was carried out with the calculation of the Spearman rank correlation coefficient (r).

Results. Women with PCOS had late-onset menopause (p=0.007) and a higher body mass index (BMI, p=0.009) than the control group. Additionally, women with PCOS had higher levels of DHEAS, total T, and 17-OHP than controls. P1NP and b-CTx were significantly different from controls (p=0.028 and p=0.032, respectively). A direct relationship was found between BMI and the activity of the resorption marker b-CTx (r=0.342, p=0.002) and an inverse collinear relationship between AMH values with b-CTx (r=–0.507, p=0.001). BMD in PCOS was higher compared to controls. An inverse relationship exists between BMD of L1–L4 and b-CTx level (r=–0.387, p=0.026) and positive with insulin (r=0.267, p=0.042), AMH (r=0.561, p=0.031) and testosterone (r=0.458, p=0.039). Higher DHEAS levels were associated with higher femoral neck BMD (r=0.473, p=0.035). P1NP was negatively correlated with femoral neck BMD (r=-0.429, p=0.038).

Conclusions. Bone mineral density in women with polycystic ovary syndrome declines more slowly with age compared to their peers, possibly due to the effects of excess androgens and insulin. In postmenopausal women with polycystic ovary syndrome, metabolic processes in bone tissue accelerate, while bone resorption exceeds bone formation. Thus, women affected by polycystic ovary syndrome may be considered at risk of developing osteopenic syndrome.