Abstract
BackgroundThere have been few studies examining the associations between menstrual irregularity, androgens and bone mass in population-based samples of premenopausal women. This study aimed to describe the associations between menstrual pattern, testosterone, sex hormone binding globulin (SHBG) and bone mass in a population-based sample of premenopausal women.MethodsCross-sectional study (N = 382, mean age 31.5 years). Menstrual pattern was assessed by questionnaire, bone mass measured by quantitative ultrasound (QUS) and androgen status was assessed by levels of serum testosterone, SHBG and the free androgen index (FAI).ResultsWomen with irregular cycles (n = 41, 11%) had higher free androgen index (FAI, P = 0.01) and higher QUS measurements including speed of sound (SOS, 1%, P < 0.05), quantitative ultrasound index (QUI, 7%, p < 0.05), and broadband ultrasound attenuation (BUA, 7%, p = 0.10). These associations persisted after adjustment for age and body mass index (BMI). After further adjustment for hormonal factors (either testosterone, SHBG or FAI), the strength of the associations was moderately attenuated, however, women with irregular cycles still had a 6% increase in mean QUS. Total testosterone, FAI and SHBG were also associated with QUS measures (testosterone and FAI, r +0.11 to +0.21, all p < 0.05; SHBG r -0.14 to -0.16, all p < 0.05) and the associations remained significant after adjustment.ConclusionIrregular menstrual cycles were associated with higher bone mass in this population-based sample of premenopausal women suggesting menstrual disturbance should continue to be evaluated but may be less harmful for bone mass. The association between menstrual irregularity and bone mass was partially mediated by markers of androgen status especially free testosterone.
Highlights
There have been few studies examining the associations between menstrual irregularity, androgens and bone mass in population-based samples of premenopausal women
Androgens may have an effect on bone metabolism in women; excess levels of androgen are associated with higher bone mass in women with Polycystic Ovary Syndrome (PCOS) [3,4,5,6,7]
Compared with other women in this study, women who were excluded due to current use of hormonal contraceptives or hormonal medications, were slightly younger (30.7 vs 31.5 years) and more likely to have a history of menstrual irregularity (21.6% vs 10.7%), but there was no significant difference in body mass index (BMI) between the groups (25.0 kg/m2 vs 24.8 kg/m2, p = 0.54) and similar proportions were current smokers (13.2% vs 14.3%, p = 0.69)
Summary
There have been few studies examining the associations between menstrual irregularity, androgens and bone mass in population-based samples of premenopausal women. This study aimed to describe the associations between menstrual pattern, testosterone, sex hormone binding globulin (SHBG) and bone mass in a population-based sample of premenopausal women. Most osteoporosis sufferers are postmenopausal women and age-related estrogen deficiency is considered a major cause of bone loss [2]. Androgens may have an effect on bone metabolism in women; excess levels of androgen are associated with higher bone mass in women with Polycystic Ovary Syndrome (PCOS) [3,4,5,6,7]. Menstrual irregularity has been associated with lower bone mass in studies of female athletes who had low BMI and extensive training [8,9,10,11]. Quantitative ultrasound (QUS) in a population-based sample of young women
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