Bone mineral density in adolescents and young women with hypogonadism: a DXA-based comparative analysis

To evaluate bone mineral density (BMD) in adolescent girls and young women with hypogonadism from a gynecologic perspective, and to compare their results with those of patients referred for clinical indications associated with bone health, such as fracture history or chronic medication use.

This retrospective study included females aged 12-21 years who underwent dual-energy X-ray absorptiometry (DXA) between January 2020 and April 2025 in a tertiary university hospital. Patients were categorized as hypogonadal or non-hypogonadal according to the indication for DXA. Lumbar spine (L1-L4) Z-scores were compared between these groups, with height adjustment applied for patients below the 3rd percentile. Demographic characteristics, vitamin D levels, and BMD Z-scores were analyzed across groups and among hypogonadism subtypes (hypergonadotropic, congenital hypogonadotropic, and functional hypothalamic amenorrhea).

Of the 74 participants, 29 (39.1%) underwent DXA because of hypogonadism. Patients with primary amenorrhea had significantly lower lumbar spine Z-scores than those with secondary amenorrhea (p<0.01). The mean lumbar spine Z-score was numerically lower in the hypogonadism group (-1.95±1.04) compared with others (-1.38±1.31), however; this was not significant (p=0.051). No significant differences were observed among hypogonadism subtypes. Mean serum 25-hydroxyvitamin D levels were low across all groups (12.9±7.7 ng/mL), indicating widespread deficiency.

Adolescent girls and young women with hypoestrogenic conditions, particularly those with primary amenorrhea exhibited lower BMD, emphasizing the essential role of estrogen in bone mass accrual during adolescence. Early diagnosis, hormone replacement, and optimization of vitamin D and calcium intake will be important for preserving bone health in this high-risk population.