Contrasting Bone Profiles in PCOS Are Related to BMI: A Systematic Review and Meta-analysis

Area of Science:

• Endocrinology
• Bone Metabolism
• Reproductive Health

Background:

• Conflicting evidence exists on whether polycystic ovary syndrome (PCOS) is protective against or increases the risk of bone frailty.
• This meta-analysis updates previous findings on PCOS and bone health.

Purpose of the Study:

• To investigate the impact of polycystic ovary syndrome (PCOS) on bone parameters in premenopausal women.
• To provide an updated meta-analysis of studies published between 2018 and 2023.

Main Methods:

• Systematic literature search of MEDLINE and Embase databases.
• Inclusion of studies published in English (2018-2023) meeting specific PCOS diagnostic criteria and quality standards (Newcastle-Ottawa Scale ≥ 6).
• Data extraction by two independent reviewers.

Main Results:

• Analysis of 31 studies (1822 PCOS, 1374 controls in cross-sectional; 30,305 PCOS, 10,1907 controls in cohort).
• Stratification by Body Mass Index (BMI) revealed distinct bone profiles.
• PCOS with BMI <27 kg/m2: lower bone density, reduced bone formation (osteocalcin), increased bone resorption (C-terminal type I collagen).
• PCOS with BMI ≥27 kg/m2: increased bone density, no significant changes in bone turnover markers (except osteocalcin).

Conclusions:

• PCOS in premenopausal women with BMI <27 kg/m2 is associated with low bone mass.
• This subgroup exhibits low bone formation and increased bone resorption, signaling heightened risk for bone frailty.
• Further research is warranted to elucidate the complex relationship between PCOS, BMI, and skeletal health.