Semin Reprod Med 2020; 38(04/05): 289-301
DOI: 10.1055/s-0041-1722849
Review Article

Musculoskeletal Health in Premature Ovarian Insufficiency. Part Two: Bone

1   Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
2   Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
3   Hudson Institute of Medical Research, Clayton, Victoria, Australia
,
Hanh H. Nguyen
1   Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
2   Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
4   Department of Endocrinology and Diabetes, Western Health, Victoria, Australia
,
Peter R. Ebeling
1   Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
2   Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
,
Frances Milat
1   Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
2   Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
4   Department of Endocrinology and Diabetes, Western Health, Victoria, Australia
› Author Affiliations
Source of Funding None.

Abstract

Accelerated bone loss and muscle loss coexist in women with premature ovarian insufficiency (POI), but there are significant gaps in our understanding of musculoskeletal health in POI. This review describes estrogen signaling in bone and its role in skeletal health and disease. Possible mechanisms contributing to bone loss in different forms of POI and current evidence regarding the utility of available diagnostic tests and therapeutic options are also discussed. A literature review from January 2000 to March 2020 was conducted to identify relevant studies. Women with POI experience significant deterioration in musculoskeletal health due to the loss of protective effects of estrogen. In bone, loss of bone mineral density (BMD) and compromised bone quality result in increased fracture risk; however, tools to assess bone quality such as trabecular bone score (TBS) need to be validated in this population. Timely initiation of HRT is recommended to minimize the deleterious effects of estrogen deficiency on bone in the absence of contraindications; however, the ideal estrogen replacement regimen remains unknown. POI is associated with compromised bone health, regardless of the etiology. Ongoing research is warranted to refine our management strategies to preserve bone health in women with POI.

Supplementary Material



Publication History

Article published online:
30 March 2021

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