Determinants of bone mineral density in women with functional hypothalamic amenorrhea, with a focus on the ultrasonographic morphology of polycystic ovaries

OBJECTIVE: To evaluate the association between polycystic ovarian morphology and bone mineral density in women with functional hypothalamic amenorrhea and to explore clinical and hormonal factors associated with reduced bone mineral density. STUDY DESIGN: This exploratory cross-sectional study included 100 consecutive women aged 18-45 years with confirmed functional hypothalamic amenorrhea. Polycystic ovarian morphology was defined according to the Rotterdam criteria. Bone mineral density was assessed by dual-energy X-ray absorptiometry at the femoral neck and lumbar spine. MAIN OUTCOME MEASURES: The primary measure of interest was the association between polycystic ovarian morphology and bone mineral density, assessed by Z-scores and the prevalence of bone mineral density below the expected range for age (Z-score ≤ -2.0). Secondary analyses examined clinical, hormonal, and lifestyle factors. RESULTS: Of the 100 women (median age 26 years), 47 had polycystic ovarian morphology. These women had higher median Z-scores at the femoral neck (-0.9 vs -1.5, p = 0.042), lumbar spine (-1.0 vs -1.2, p = 0.041), and minimum Z-score (-1.2 vs -1.7, p = 0.011). In multivariable analysis, polycystic ovarian morphology remained independently associated with a higher minimum Z-score (ß = 0.363, p = 0.007). Bone mineral density below the expected range for age was observed in 27.7% of women with polycystic ovarian morphology and 37.7% of women without polycystic ovarian morphology (p = 0.297). CONCLUSION: Polycystic ovarian morphology was independently associated with a higher minimum bone mineral density Z-score in women with functional hypothalamic amenorrhea. Prospective longitudinal studies are warranted to further evaluate this association.