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Bone mineral density, vertebral fractures and trabecular bone score in primary ovarian insufficiency

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Abstract

Purpose

Bone health in primary ovarian insufficiency (POI) is under-investigated. We assessed patients with spontaneous POI for vertebral fractures (VFs) and related parameters of bone health.

Methods

70 cases with spontaneous POI (age 32.5 ± 7.0 years) and an equal number of controls were assessed for BMD, TBS, and VFs. BMD at the lumbar-spine (L1-L4), left hip, non-dominant forearm, and TBS (iNsight software) were measured on a dual-energy X-ray absorptiometry (DXA) machine. VFs were assessed by Genant’s classification. Serum FSH, LH, estradiol, T4, TSH, iPTH, serum 25(OH)D, total calcium, and inorganic phosphorus were measured.

Results

BMD at the lumbar-spine, hip and forearm was reduced by 11.5%, 11.4% and 9.1% in POI as compared to controls (P < 0.001). Degraded or partially degraded microarchitecture on TBS was observed in 66.7% of patients and 38.2% of controls (P = 0.001). 15.7% of the POI patients had VFs, compared to 4.3% of controls (P = 0.045). Age, duration of amenorrhea and duration of HRT use were the significant predictors of TBS (P < 0.01). Serum 25(OH)D was the significant determinant of VFs. TBS abnormalities were higher in patients with POI and VFs. BMD was not significantly different in patients with and without VFs.

Conclusion

Thus, lumbar-spine osteoporosis, impaired TBS and VFs were present in 35.7%, 66.7% and 15.7% of patients with spontaneous POI in their early third decade. This indicates need for rigorous investigations for impaired bone health in these young patients and management with HRT, vitamin-D, and possible need for bisphosphonate therapy.

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Data availability

All datasets generated during and/or analysed during the current study are not publicly available but will be available from the corresponding author upon reasonable request.

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Acknowledgements

The help of Dr. Vishnubhatla Sreenivas in statistical analysis is acknowledged. The help of Mr. Sushil in DXA scanning is acknowledged.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Departments of Obstetrics and Gynecology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India

    M. Dhakate & D. Goswami

  2. Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, 110029, India

    R. Goswami & S. Saha

  3. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India

    D. Kandasamy

  4. Department of Dietetics, Maulana Azad Medical College, New Delhi, 110002, India

    M. Arora

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  1. M. Dhakate
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  2. D. Goswami
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  3. R. Goswami
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  4. S. Saha
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  5. D. Kandasamy
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  6. M. Arora
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Contributions

DG and RG were responsible for the concept of the study. MD and DG were responsible for the recruitment of study subjects. MD was responsible for their DXA scanning, blood sampling, and compilation of results. RG was responsible for data analysis and the interpretation of results. SS contributed to the recruitment of subjects, investigations, and data analysis. DK contributed to the interpretation of the DXA scans. MA collected and analysed the dietary data for POI patients. RG and DG wrote the manuscript. DG supervised the study and did the final revision of the manuscript.

Corresponding author

Correspondence to D. Goswami.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

The study was performed in accordance with the ethical standards as laid down in the declaration of Helsinki, and was approved by the Institutional Ethics Committee of Maulana Azad Medical College, New Delhi, India.

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Informed consent was obtained from all individual participants included in the study.

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Dhakate, M., Goswami, D., Goswami, R. et al. Bone mineral density, vertebral fractures and trabecular bone score in primary ovarian insufficiency. J Endocrinol Invest 46, 1865–1874 (2023). https://doi.org/10.1007/s40618-023-02045-z

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