Association between pelvic floor disorders and bone mineral density: Findings from the HUNT study

Sigrid Aspli,Sigrid Anna Aalberg Vikjord,Arnulf Langhammer,Julie Horn

doi:10.1016/j.ejogrb.2022.02.002

Abstract

ObjectivesTo examine the association between pelvic floor disorders (pelvic organ prolapse, urinary incontinence and anal incontinence) and bone mineral density (BMD).Study design: A cross-sectional study of 6809 women who participated in the third survey of the population-based Norwegian HUNT study was undertaken. BMD was measured by dual-energy X-ray absorptiometry. Information on BMD and self-reported pelvic floor disorders from the HUNT study was linked with hospital-derived data on diagnosis and surgical treatment of pelvic floor disorders. BMD was categorized according to the World Health Organization criteria (normal, osteopenia and osteoporosis). Multi-variate logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for the association between pelvic floor disorders and BMD. ResultsWomen with a hospital diagnosis of stress urinary incontinence (SUI) were less likely to have osteopenia (OR 0.66, 95% CI 0.50–0.87) or osteoporosis (OR 0.66, 95% CI 0.34–1.30) compared with women without a diagnosis of SUI. In women with self-reported information on pelvic floor disorders, women with a history of SUI had lower odds for osteopenia (OR 0.88, 95% CI 0.75–1.02) or osteoporosis (OR 0.69, 95% CI 0.46–1.01), while no association was found between anal incontinence, self-reported surgery for pelvic organ prolapse, and osteopenia or osteoporosis. ConclusionPelvic organ prolapse was not associated with BMD. The reasons underlying the observed association between SUI and BMD require further investigation.

Highlights

Together with the other Scandinavian countries, Norway is world leading in the prevalence of osteoporosis and low-energy fractures [1,2,3]
Women with osteopenia or osteoporosis were more likely to report early age at menopause and had a lower body mass index (BMI) compared with women with normal bone mineral density (BMD) (Table 1)
Diagnosis, surgical treatment and self-reported symptoms of stress urinary incontinence (SUI) were associated with decreased odds of osteopenia or osteoporosis

Summary

Introduction

Together with the other Scandinavian countries, Norway is world leading in the prevalence of osteoporosis and low-energy fractures [1,2,3]. Osteoporotic fractures are associated with increased morbidity and mortality, and impose a substantial burden on individuals, health care systems and society [1,4]. Fractures resulting from osteoporosis are increasingly common in postmenopausal women [4], and depending on which skeletal part is measured, approximately one in 10 Norwegian women aged > 50 years are osteoporotic according to the World Health Organization’s (WHO) definition [5]. There are well-known therapeutic measures to prevent osteoporotic fractures, and identifying individuals at risk has the potential for significant impact for both individuals and healthcare systems. The fracture-related burden is expected to increase further over the decades, mainly due to population ageing, and previous studies have called for more preventive action to identify and treat individuals at risk [1,4,6]

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