Premature Ovarian Insufficiency and Bone Health Care: A Concern of the Gynecologist - Revista Brasileira de Ginecologia e Obstetrícia
In the literature, there are no evidence-based guidelines on criteria to maintain bone health in women with POI. It has not been definitively demonstrated that a reduced BMD in POI is indicative of an association of the disease with an increased fracture risk because the evidence is based on short-term observations and expert opinion. In fact, studies with the clear aim to clarify this cause-effect relationship are difficult to perform because they would involve ethical issues (for example, failure to treat patients on estrogen therapy as a control group), or the high cost and long duration of the follow-up, since the patients should be observed for long periods.
Moreover, the results of BMD studies performed in postmenopausal women cannot be extrapolated to a population of young women with estrogen deficiency before the age of 40 years old in order to predict fractures that will occur 20 to 30 years later, when other risk factors for fractures may be involved.
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In the literature, there are no evidence-based guidelines on criteria to maintain bone health in women with POI. It has not been definitively demonstrated that a reduced BMD in POI is indicative of an association of the disease with an increased fracture risk because the evidence is based on short-term observations and expert opinion. In fact, studies with the clear aim to clarify this cause-effect relationship are difficult to perform because they would involve ethical issues (for example, failure to treat patients on estrogen therapy as a control group), or the high cost and long duration of the follow-up, since the patients should be observed for long periods.
Moreover, the results of BMD studies performed in postmenopausal women cannot be extrapolated to a population of young women with estrogen deficiency before the age of 40 years old in order to predict fractures that will occur 20 to 30 years later, when other risk factors for fractures may be involved.
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