Bone mineral density and sex hormone status in intellectually disabled women on progestin‐induced amenorrhea

Abstract

To evaluate bone mineral density (BMD) and hormonal status in female patients with intellectual disability and a history of progestin-induced amenorrhea. Cross-sectional study. Nursing home. The study included 51 patients with a history of therapeutic amenorrhea (age 23-77 years, mean 45 years); 115 staff members (age 21-64 years, mean 45 years) at the same nursing homes served as controls. Calcaneal BMD was measured for all (Peripheral Instantaneous X-ray Imaging Lunar Bone Densitometer); blood samples for serum levels of estradiol (E(2)), follicle stimulation hormone (FSH) and lutenizing hormone (LH) were obtained only for the patients. The patients showed significantly lower age and weight-adjusted BMD than the controls (0.35 g/cm(2)+/-0.13 vs. 0.53 g/cm(2)+/-0.09, p<0.001). BMD values did not differ between pre- (N=29) and postmenopausal (N=22) patients. Osteoporosis was observed in 57% of the patients and only in 2% of the controls. Four patients (8%) but none of the controls had sustained a bone fracture during the preceding five years. Most premenopausal patients had hypogonadotropic hypogonadism, as shown by low serum E(2), LH and FSH levels in 83%, 69%, and 59% of the cases. Postmenopausal patients showed normal hormonal status for their age. Osteoporosis with concomitant fractures is prevalent in women with intellectual disability on therapeutic amenorrhea. Progestin-induced amenorrhea results in hypogonadism, an established risk factor for osteoporosis. New strategies for the management of menstruation should be considered.