Comparison of bone mineral density and influencing factors in iatrogenic and idiopathic POI.

OBJECTIVE

This study aimed to investigate the characteristics of bone mineral density (BMD) in patients with premature ovarian insufficiency (POI), compare BMD between iatrogenic POI and idiopathic POI patients, and investigate the factors affecting BMD in POI patients.

METHOD: This cross-sectional study recruited a total of 88 iatrogenic POI patients, 45 idiopathic POI patients and 45 normal reproductive-age women, all of whom met the study criteria and were treated at the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from 1 January 2023 to 30 June 2024. Medical history was collected for all patients, and follicle stimulating hormone (FSH), estradiol (E2), total testosterone (TT), free testosterone (FT), biologically active testosterone (BioT), dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) were measured. Height and weight were measured, and the body mass index (BMI) was calculated. BMD of the lumbar spine and left femur was measured in POI patients. Multiple linear regression analyses were performed to determine the correlation between characteristics and BMD.

RESULTS

The incidence of osteoporosis was significantly higher in iatrogenic POI patients than in idiopathic POI patients (40.9% vs. 20.0%, p < 0.05). The femoral shaft BMD, greater trochanter BMD t-score, total femoral BMD and total femoral BMD t-score were significantly lower in iatrogenic POI patients compared to idiopathic POI patients (all p < 0.05). Multiple linear regression analysis revealed that delay in diagnosis negatively affected the lumbar BMD t-score (p < 0.05) and the BMI and DHEAS positively affected the total femur BMD t-score in iatrogenic POI patients (p < 0.05). No significant correlations were found in idiopathic POI patients.

CONCLUSION

The incidence of osteopenia and osteoporosis in POI patients is high, especially in iatrogenic POI patients, who experience more severe bone loss and a higher incidence of osteoporosis. BMI and a delay in diagnosis significantly affected BMD in iatrogenic POI patients. This, to our knowledge, is the first study showing that DHEAS positively affects BMD in iatrogenic POI patients, which, however, needs further studies for confirmation.