Menstrual history as a determinant of current bone density in young hirsute women

Abstract

There is evidence that bone mass is influenced by estrogen, declining in situations characterized by a decrease in the production of this hormone. Usually, amenorrhea and oligomenorrhea are associated with a state of hypoestrogenism, and both situations are frequent in hirsute patients. The aim of the present study was to analyze the relationship between bone mass and menstrual cyclicity in hirsute women. A total of 52 nulliparous women complaining of hirsutism in various degrees with associated oligomenorrhea/amenorrhea (OA) in 27 cases and eumenorrhea in 25 were included in this study. Basal serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol-17β (E2), prolactin (PRL), testosterone (T), androstenedione (A4) dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone (OHP), and SHBG were determined, and the area under the curve (AUC) for E2 was plotted. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry (DEXA). The mean age for eumenorrheic patients was 26 years (range, 17 to 31), and for OA patients, 24 (range, 16 to 29). Both groups had similar Ferriman-Gallwey scores. Basal levels of PRL, LH, FSH, E2, T, A4, OHP, and DHEAS were similar for eumenorrheic and OA patients. The AUC for E2 was significantly higher for eumenorrheic patients, and DEXA at the lumbar spine demonstrated a significant difference between eumenorrheic (1.222 ± 0.240 g/cm 2) and OA (1.016 ± 0.108 g/cm 2) hirsute women ( P < .01). In conclusion, OA, due to a relative hypoestrogenism, may be correlated with osteopenia in young hirsute women.