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Increased risk of fractures in patients with polycystic ovary syndrome: a nationwide population-based retrospective cohort study

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Abstract

Polycystic ovary syndrome (PCOS) is a complex disorder; various features of this disorder may influence bone metabolism and skeletal mass. The contribution of PCOS to lower bone mineral density has been recognized. However, the impact of PCOS on the long-term risks for fractures remains inconclusive. The aim of this study was to determine the risk of overall fracture and fractures at different anatomic sites in patients with PCOS. Using a nationwide health insurance claims database, we included 11,106 subjects, aged 15–80 years, with newly diagnosed PCOS (ICD-9-CM: 254.4X) during 2000–2012. Patients with PCOS and respective age-matched (1:4) controls without PCOS were enrolled. The occurrence of fracture was monitored until the end of 2013. Cox regression and computed hazard ratios (HR) with 95% confidence intervals (95% CI) were used to determine the risk of PCOS among women with fractures. The PCOS and non-PCOS groups were comprised of 11,106 patients with PCOS and 44,424 participants without PCOS, respectively. Patients with PCOS had a higher incidence of any fractures compared with non-PCOS group (10.16 versus 8.07 per 1000 person-years) and a greater risk of any fractures [adjusted hazard ratio (aHR) = 1.23, 95% CI = 1.13–1.33], osteoporotic fractures (aHR = 1.33, 95% CI = 1.15–1.54), spine fractures (aHR = 1.36, 95% CI = 1.11–1.66) and forearm fractures (aHR = 1.39, 95% CI = 1.07–1.80), but the risk for femur or hip fracture, humerus, wrist and non-osteoporotic fractures were not increased. In conclusion, the PCOS group had a higher occurrence rate of fractures than the non-PCOS group. These results provide evidence for the adverse effects of PCOS on the risk of fractures.

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Acknowledgements

This study was based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance and the Department of Health and Welfare and managed by the National Health Research Institutes. The interpretation and conclusions contained within do not represent those of the Bureau of National Health Insurance, Department of Health or National Health Research Institutes.

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Authors and Affiliations

  1. Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, 600, Taiwan

    Hsin-Yi Yang, Wan-Ting Huang & Yueh-Han Hsu

  2. Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 813, Taiwan

    Herng-Sheng Lee

  3. Department of Obstetrics and Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, 407, Taiwan

    Ming-Jer Chen

  4. Heng Chun Christian Hospital, Pingtung County, 946, Taiwan

    Solomon Chih-Cheng Chen

  5. Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, 110, Taiwan

    Solomon Chih-Cheng Chen

  6. Department of Medical Research, China Medical University Hospital and China Medical University, Taichung, 404, Taiwan

    Yueh-Han Hsu

  7. Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhong-Xiao Road, Chia-Yi, 600, Taiwan

    Yueh-Han Hsu

  8. Department of Nursing, Min-Hwei College of Health Care Management, Tainan, 736, Taiwan

    Yueh-Han Hsu

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  1. Hsin-Yi Yang
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Correspondence to Yueh-Han Hsu.

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Yang, HY., Lee, HS., Huang, WT. et al. Increased risk of fractures in patients with polycystic ovary syndrome: a nationwide population-based retrospective cohort study. J Bone Miner Metab 36, 741–748 (2018). https://doi.org/10.1007/s00774-017-0894-8

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  • DOI: https://doi.org/10.1007/s00774-017-0894-8

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