Dissertação
Saúde óssea de pacientes com síndrome dos ovários policísticos: revisão sistemática e metanálise
Fecha
2018-12-20Autor
Piovezan, Júlia Mottecy
Institución
Resumen
Background: Polycystic ovary syndrome (PCOS) has reproductive and metabolic aspects that
may affect bone health. Controversial results from different studies led to uncertainty whether
PCOS might improve or deteriorate bone health. Objective and rationale: This study aimed to
investigate the impact of PCOS on bone markers, bone mineral density (BMD) and fracture
risk. Search methods: A systematic review and meta-analysis was carried out. PubMed,
EMBASE and Cochrane databases were searched for eligible studies from 1st of January of
1990 to 9th of October of 2018. Eligible studies enrolled women older than 18 years with
PCOS, which should be diagnosed by the Rotterdam Consensus, the Androgen Excess
Society, the National Institutes of Health Consensus or the International Classification of
Diseases. The studies were grouped according to the patients’ mean body mass index (BMI):
<27 kg/m2 or ³ 27 kg/m2. The results were polled as mean difference (MD), standardised
mean difference (SMD) and hazard ratio (HR). Outcomes: Overall, 921 studies were
retrieved, and 31 duplicated studies were removed. After screening the titles and abstracts, 80
studies were eligible for full-text reading. Of those, 23 studies remained for qualitative
synthesis. With the exception of one study, all studies were considered high quality based on
the Newcastle-Ottawa scale (NOS; score ³6). Meta-analysis was performed in 21 studies, with
a total of 31,383 women with PCOS and 102,797 controls. Women with PCOS with BMI<27
kg/m2 had lower BMD of the total femur (MD, -0.04; 95% confidence interval [CI], -0.07 to
0.00; I2=31%; p=0.22) and spine (MD, -0.07; 95% CI, -0.13 to -0.01; I2=70%; p<0.01) when
compared with the control group, whereas women with BMI³27 kg/m2 had no difference
(femur: MD, 0.02; 95% CI, -0.02 to 0.05; I2=20%, p=0.29; spine: MD, 0.02; 95% CI, -0.06 to
0.05; I2=0%; p=0.84). Osteocalcin was remarkably reduced in women with PCOS with
BMI<27 kg/m2 (SMD, -2.68; 95% CI, -4.70 to -0.67; I2=98%; p<0.01), but in women with
BMI³27 kg/m2, there were no differences between PCOS and controls. Few studies (n=3)
addressed the incidence of bone fractures in women with PCOS. The HR for total bone
fractures did not identify differences between women with PCOS and controls. Wider
implications: On the basis of the available evidence, it is possible to assume that PCOS is
associated with unfavourable impact on bone health. Women with PCOS exhibited reduced
BMD in the spine (trabecular bone) and decreased bone formation, as manifested by lower
levels of circulating osteocalcin. However, many of these studies included premenopausal
women, who have not yet achieved peak bone mass. Hence, further prospective studies are
necessary to clarify the existence increased risk of fractures in women with PCOS.