Primary Ovarian Insufficiency Linked to Osteoporosis

By Marilynn Larkin

March 15, 2021

NEW YORK (Reuters Health) - Primary ovarian insufficiency (POI) was tied to an increased risk of osteoporosis in a large Canadian cohort study.

"There is accumulating evidence demonstrating that an earlier menopause, which represents an early loss of ovarian function, has long-term effects on several health outcomes," Dr. Alison Shea of McMaster University in Hamilton told Reuters Health by email.

After adjustment, she said, "we found that a history of POI increase(d) the odds ratio of having current osteoporosis as measured using bone mineral density (BMD) values. Our findings are particularly exciting because both patient-reported . . . and objective BMD measures for osteoporosis were increased in women who had an earlier loss of ovarian function."

"Both past and current use of hormone therapy were found to decrease the odds for osteoporosis, as measured using current BMD," she added. "Generally, the replacement of reproductive hormones is recommended until the average age of menopause (51 in North America), in the absence of contraindications."

As reported in Menopause, Dr. Shea and colleagues analyzed data from more than 12,000 women (mean age at assessment, 65) participating in the Canadian Longitudinal Study on Aging. The mean age of menopause was 35 for the POI group, 43 for those with early menopause, 51 for those with normal menopause, and 58 for those with late menopause.

Overall, compared with women with normal-age menopause, those in the POI group were more likely to be obese (40% vs. 27%), have decreased physical activity (25% vs. 19%), and be current smokers (14% vs. 6%).

No differences in hip BMD were seen between women with POI and those with early and normal ages of menopause. However, women in the POI group were more likely to have a higher rate of self-reported osteoporosis (22% vs. 17%) and to have used osteoporosis drugs (11% vs. 8%).

After adjustment for factors such as age, education, BMI, and smoking, POI was associated with a significantly higher risk of osteoporosis, as diagnosed using BMD (odds ratio, 1.69), while obesity was linked to a lower risk (OR, 0.39).

Dr. Richard Leach, professor and chair, Department of Obstetrics, Gynecology and Reproductive Biology at Michigan State University in East Lansing, noted that the study used one of the largest datasets of its kind and was "well done."

"Women with POI had lower rates of secondary and postsecondary graduation and lower annual income," he noted. "They were more likely to be current smokers, have decreased physical activity and higher nutritional risk. The identified weaknesses of the study included that the data set did not include participant information on nutritional supplements including calcium, or corticosteroid use, and self-reporting of menopause onset."

For women with POI, he said, "Providers can reinforce and provide behavioral support resources to reduce modifiable risks factors, including smoking cessation, increased weight-bearing exercise and calcium supplementation."

SOURCE: Menopause, online March 1, 2021.