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Less osteoporosis with PCOS
Title: Bone mineral density, androgens, and the polycystic ovary: The complex and controversial issue of androgenic influence in female bone
Author: J. Zborowski, et al.
Address: Pittsburgh, Pennsylvania
Source: The Journal of Clinical Endocrinology & Metabolism 85:3496-3506 (October) 2000
Summary: PCOS usually appears at the time of puberty and is believed to be one of the most prominent endocrine disorders among women of reproductive age. Because PCOS is so common and because it presents so early in life, it is thought to be an important model for determining the effects of androgen and potentially insulin on the attainment of maximal bone mass. Osteoporosis in women is not only the result of aging and estrogen-dependent bone loss during menopause, but also of peak skeletal mass attained and maintained during young adulthood. Therefore, researchers prepared this review article with four objectives in mind: 1) to summarize the available literature that explores the androgen-bone mass relationship in normal women; 2) to assess the effects of PCOS, androgen excess and androgen-estrogen balance on bone mass in women; 3) to examine study design issues in relation to PCOS, androgen excess, and bone mass; and 4) to suggest areas for future research related to the influence of PCOS, androgen excess, and insulin on bone. The authors noted that various lines of evidence in both normal women and those with PCOS tend to support an independent association of androgens with peak bone mass attainment and maintenance in premenopausal women. Women with PCOS tend to be overweight and that body weight is a key predictor of bone mass and is collinear with sex steroids. Differences in regional body composition may contribute to site-specific increases in BMD in PCOS. The higher bone density seen in PCOS/hirsute women with regular menses suggests that estrogens and androgens may interact to determine bone density. When there is sufficient estrogen, androgens may have a positive effect on bone. It has not been established that all women with PCOS are exempt from osteopenia because obesity, hyperandrogenemia, and hyperinsulinemia, the characteristics of PCOS that may have a positive influence on bone mass, are not present in every woman with PCOS.