MON-211 The Negative Impact of Polycystic Ovary Syndrome in Bone Health: A Systematic Review and Meta-Analysis

Polycystic ovary syndrome (PCOS) exhibit reproductive and metabolic aspects that may affect bone health. Controversial results from different studies given uncertainty whether PCOS might improve or negatively impact bone health. Therefore, this study aimed to investigate through a systematic review and meta-analysis the impact of PCOS on bone markers, bone mineral density (BMD), and the risk of fractures. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42016049664. We performed a systematic review of randomized controlled trials (RCTs), cohort studies, cross-sectional studies, and case-control studies. Studies evaluating women PCOS over 18 years were included. We considered eligible studies in which the PCOS diagnosis was one of the following: The Rotterdam Consensus, AES, NIH or ICD. The outcomes reported should be BMD, bone markers, or incidence of fractures. The search was performed at PubMed, EMBASE, and the Cochrane Library. In total, 921 studies were found, of which 31 were duplicates. After screening the title and abstracts, 80 studies were eligible for full-text reading. Of those, 25 studies remained for qualitative synthesis. All studies were stratified according to the mean BMI of PCOS patients higher or equal to 27 kg/m2 or lower than 27 kg/m2. PCOS women with BMI lower than 27 kg/m2 had a lower BMD of the total femur [mean difference (MD) (CI95%)] [-0.04 (-0.07, 0.00), I2=31%, p=0.22] and spine [-0.07 (-0.13, -0.01), I2 70%, p<0,01] when compared with the control group, while women with BMI > 27 kg/m2 had no difference [femur = 0.02 (-0.02, 0.05), I2=20%, p=0.29; and spine = 0.02 (-0.06,0.05), I2 = 0, p=0.84]. Osteocalcin was remarkably reduced in PCOS women with BMI < 27 kg/m2: -2.68 (-4.70; -0.67), I2= 98%, <0.01. Again, in PCOS with BMI > 27 kg/m2, there was no difference between PCOS and control. Few studies (n=3) addressed the incidence of bone fractures in women with PCOS. The Hazard Ratio for total bone fractures did not identified differences between women with PCOS and controls. Our results suggest that PCOS women with < 27 kg/m2 exhibit a lower BMD (femur and vertebral) and a reduced marker of bone formation (osteocalcin). Further studies are necessary to clarify this risk of fractures.