Timely diagnosis is vital: The effect of delayed diagnosis on bone mineral density in women with premature ovarian insufficiency

Background: The long-term effect of Premature Ovarian Insufficiency
(POI) on bone mineral density (BMD) is well recognised.
Little is known about the early effects of POI on the rate of bone
loss or the consequences of delayed diagnosis. The aim of this study was to explore the effect of aetiology and time to diagnosis on BMD
in POI.
Methods: Retrospective database analysis of 563 patients from
the West London Menopause and PMS Centre, where data is
recorded in the International POI Registry.
Results: 563 patients were included in the analysis. Aetiology
was classified as idiopathic (60.4%), genetic (2.1%) or iatrogenic
following treatment for malignancy (25.6%) or benign conditions
(11.9%).
Overall, at the time of diagnosis 32.3% had osteopenia and 4.3%
had osteoporosis.
Mean T score in patients with idiopathic POI was significantly
lower at both the spine (p = 0.001) and hip (p = 0.02) than in patients
with iatrogenic POI.
Time to diagnosis was significantly longer in women with idiopathic
POI (median 12 months) compared to iatrogenic POI (median
0 months) (p = 0.001).
Longer time to diagnosis was associated with lower BMD. For
every 1 month increase in time to diagnosis the BMD measured
decreased by 0.026 at the spine (p = 0.001) and 0.018 at the femur
(p = 0.013).
Women with an underlying genetic cause had high rates of
osteopenia (25%) and osteoporosis (25%). This may be because they
are diagnosed at a significantly younger age (mean 23.7 years) compared
to other aetiologies (idiopathic mean 33.2 years, benign 32.6
years, cancer 31.1 years) (p < 0.0001).
Conclusions: Delayed diagnosis is common in women with POI
and has a detrimental effect on BMD. The NICE Guidelines now
include clear diagnostic criteria for POI. Early diagnosis is essential
to ensure timely treatment and prevention of bone loss.