Prevalence of Impaired Bone Health in Premature Ovarian Insufficiency and Early Menopause and the Impact of Time to Diagnosis.

Background/

Objectives

Premature ovarian insufficiency (POI) is a leading cause of hypoestrogenism in women under the age of 40 years and is associated with an increased risk of impaired bone health. Early diagnosis and timely hormonal intervention are essential to prevent irreversible bone loss. However, diagnostic delay is not uncommon in clinical practice.

Methods

We conducted a retrospective analysis of 168 women diagnosed with POI or early menopause (EM) between 2017 and 2024 at a tertiary gynecological endocrinology unit. Bone mineral density (BMD) and T-score were assessed by dual-energy X-ray absorptiometry (DXA) at the time of diagnosis in 125 patients, of whom 116 had secondary amenorrhea. The interval between the last menstrual period (LMP) and diagnosis was used to assess the impact of diagnostic delay. The patients were further stratified by serum estradiol (E2) levels and body mass index (BMI).

Results

At the time of diagnosis, 43.1% of patients had osteopenia, and 10.3% had osteoporosis. A statistically significant negative correlation was observed between time to diagnosis and BMD (r = -0.225, p = 0.022), with a similar trend seen for T-score (r = -0.211, p = 0.031). In patients with E2 ≤ 5 ng/L, the association was stronger (BMD: r = -0.401, p = 0.026). Lower E2 levels tended to be associated with poorer bone health in women with a BMI < 25 kg/m2, whereas no such trend was observed in those with a higher BMI.

Conclusions

Our findings indicate that diagnostic delay in POI is associated with deterioration in bone health, particularly in lean patients and those with severe hypoestrogenism. These results underscore the importance of early recognition and timely initiation of hormone therapy to preserve bone mass and reduce long-term skeletal complications.