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Increased Bone Density in Hirsute Women
Title:Augmentation of Bone Mineral Density in Hirsute Women
Author:S.Dagogo-Jack et al.
Address:St Louis Missouri and Mubarek, Kuwait
Source: Journal of Clinical Endocrinology and Metabolism 82: 2821-2825 (Sept)1997
Summary:The possible protective effects of hyperandrogenism and oligomenorrhea on bone mineral density (BMD) are investigated in this study of 32 hirsute women. BMD and bone mineral content (BMC) were measured using dual energy x-ray absorptiometry. The control group consisted of 25 matched non-hirsute women reporting normal menses.. Of the hirsute women , 21 reported normal menses and 11 reported oligomenorrhea. As hypothesized, total BMD results were higher in the hirsute women (1.202+0.02 vs. 1.116+0.02 g/cm2 , Pless than 0.01, lumbar spine BMD (1.183+0.02 vs 1.125+0.02 g/cm2, P less than 0.01, and total BMC (2700+66 vs. 2400+70 g, P less than 0.001. Serum total testosterone levels were similar, but androstenedione levels were higher (11.7+0.80 vs 7.9+0.79 nmol/L,P less than 0.005 and sex hormone binding globulin levels lower (22.0+3.0 vs. 57.6+8.5 nmol/L,P less than 0.001) in hirsute women. Eumenorrheic hirsute women had the highest BMD, followed by the oligomenorrheic hirsute women with the control nonhirsute group having the lowest BMD. The authors conclude that hirsutism is associated with higher bone density and mineral content, consistent with a net positive effect of hyperandrogenism on skeletal mass.
Comment:The PCOS patients that we are now treating for infertility will get older with new health concerns. Several earlier studies have suggested that PCOS patients, despite their menstrual dysfunction, are somewhat protected from osteoporosis. A question that remains unanswered, at least in the present study, is the relationship with weight. Weight also has been shown to be protective against osteoporosis. On average, the PCOS group in this study were 10 pounds heavier than controls. In a simplest approach, I consider patients with menstrual dysfunction as either hypogonadal, with low steroid levels, or hypergonadal with higher or unopposed ovarian steroids. In the former, hormone replacement is critical, but not necessarily so in the latter.