Increased risk of humerus and lower leg fractures in postmenopausal women with self-reported premenopausal hirsutism and/or oligomenorrhea

Abstract

Objective

The aim of this study was to investigate the prevalence of fracture in women aged >55 years with self-reported premenopausal hirsutism and/or oligomenorrhea.

Study design

A cross-sectional study including 1057 post-menopausal women aged >55 years who were treated in a primary care facility in Santa Maria, South Brazil, from March 2013 through August 2013. Data were collected using a standardized questionnaire for characteristics including fracture history, medication use, and reproductive history (oligomenorrhea, hirsutism, miscarriage, the diagnosis or treatment of hypothyroidism, hyperprolactinemia, or infertility).

Results

A non-significant trend towards an increased prevalence of all fragility fractures was observed in women with premenopausal hirsutism and/or oligomenorrhea when compared to those without (20.4% vs. 15.7%). After correction for age, falls, and comorbidities, fracture prevalence was significantly higher in the lower leg (OR 3.1 [CI 1.1–8.6]; P = 0.029), and humerus (OR 2.6 [CI 1.2–5.4]; P = 0.015) in the women with hirsutism and/or oligomenorrhea.

Conclusion

This is a hypothesis-generating study which evaluated the association between hirsutism and/or oligomenorrhea and fractures in postmenopausal women. Our results suggest that premenopausal hirsutism and/or oligomenorrhea may be associated with an increased risk of fracture postmenopause, particularly in the humerus and lower leg.

Introduction

Fragility fractures are one of the major emerging causes of disability and reduced quality of life in elderly women. Premature menopause and premenopausal amenorrhea are well-established risk factors, but it is uncertain whether conditions associated with oligomenorrhea, for example polycystic ovary syndrome (PCOS), increase fracture risk later in life.

Hirsutism affects 5–15% of women and is one of the clinical manifestations of androgen excess during the reproductive years [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Hirsutism can be a manifestation of peripheral pilosebaceous sensitivity to normal levels of testosterone, but is frequently associated with hyperandrogenic states such as PCOS or congenital adrenal hyperplasia [11], [12], [13]. Several studies have shown that up to 80% of women with increased hair and regular menstrual cycles fulfill the criteria for the diagnosis of PCOS since abnormal polycystic ovaries were demonstrated by ultrasound procedures [10], [14].

Few reports have focused on the evaluation of bone metabolism in hirsute and\or hyperandrogenic women. In premenopausal women with PCOS investigations of bone mineral density (BMD) values have shown conflicting results. Women with PCOS presented with lower [15], [16], [17], [18], similar [19] or higher [20], [21] BMD than controls. Moreover a recent study in premenopausal women with PCOS observed a higher cortical density in the tibia, demonstrated by peripheral quantitative computed tomography (pQCT) in comparison to normal women without PCOS [22]. Conversely, Schmidt et al. identified a non-significant trend towards increased fracture incidence in postmenopausal women with a history of PCOS (n = 25) after a follow-up of 21 years (56% vs. 41%) when compared with age-matched controls (n = 68) [23].

Although self-reported premenopausal hirsutism and/or oligomenorrhea appears to be a reliable indicator of hyperandrogenism in postmenopausal women [24], [25] it is unclear whether these clinical manifestations have a relationship with the prevalence of fractures in postmenopausal women. The aim of this study was therefore to investigate if self-reported hirsutism and/or oligomenorrhea during the reproductive years is associated with increased fracture prevalence postmenopause.