Poor Compliance to Hormone Therapy and Decreased Bone Mineral Density in Women with Premature Ovarian Insufficiency.

Anne Bachelot,Carole Nicolas,Philippe Touraine,Solenne Gricourt,Jérôme Dulon,Jean Louis Golmard,Monique Leban,Bart O Williams

doi:10.1371/journal.pone.0164638

Abstract

Premature ovarian insufficiency leads to through infertility and estrogen deficiency. Optimal management encompasses estrogen replacement therapy. Long-term outcome of women with POI is not known. We design a study to evaluate the medical care, hormone replacement therapy compliance and bone mineral density (BMD) in POI women with at least a five-year follow-up after the first evaluation. One hundred and sixty-two patients (37.3±8.0 years) were evaluated (follow-up 7.9±2.8 years). Sixty-nine patients (42.6%) had stopped their hormone replacement therapy (HRT) for at least one year during the follow up period. BMD determination at initial evaluation and at follow-up visit was completed in 92 patients. At first evaluation, 28 patients (30%) had osteopenia and 7 (8%) had osteoporosis. At follow up, 31 women (34%) had BMD impairment with osteopenia in 61% and osteoporosis in 5%. In univariate analysis and multivariate analysis, there was a significant loss of femoral BMD in women who had stopped their HRT for over a year. In conclusion, this first study concerning long-term follow-up of POI patients shows the poor compliance to their HRT, despite its importance in the prevention of bone demineralization. This study reinforces the need for follow up and specific care for POI women.

Highlights

Premature ovarian insufficiency (POI) is a disorder affecting approximately 1% of women under 40 years of age [1]
Very few studies focus on the following up women with primary POI or in the impact of hormone replacement therapy (HRT) in these women
We found a high prevalence of bone mineral density (BMD) impairment, especially in patients who stopped their HRT

Summary

Introduction

Premature ovarian insufficiency (POI) is a disorder affecting approximately 1% of women under 40 years of age [1]. POI encompasses a heterogeneous spectrum of conditions, through two major mechanisms: follicle dysfunction and follicle depletion [2]. Causes such as autoimmunity, monosomy X and environmental factors play a role in POI, the aetiology in most cases remains unknown [3]. Besides impairing the quality of life through infertility and estrogen deficiency, the longterm outcome of these women is not known. PLOS ONE | DOI:10.1371/journal.pone.0164638 December 1, 2016

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Results

Conclusion