Vasomotor symptoms in infertile premenopausal women

a hitherto unappreciated risk for low bone mineral density

Lubna Pal, John Norian, Gohar Zeitlian, Kris Bevilacqua, Ruth Freeman, Nanette Santoro

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To identify the prevalence of vasomotor symptoms (VMS) in a population of premenopausal infertile women and to determine whether VMS is associated with enhanced bone turnover and low bone mineral density (BMD). Design: Cross-sectional study. Setting: Academic infertility practice. Patient(s): Eighty-two premenopausal infertile, but otherwise healthy, women attending for routine infertility care. Intervention(s): Bone mineral density testing, general health and Profile of Mood States questionnaires, and serum samples (cycle d 1-3). Main Outcome Measure(s): Vasomotor symptoms, specifically hot flashes (HF) and night sweats (NS); BMD z score, BMD categorized as low (Z ≤ -1.0) or normal (Z > -1.0); ovarian reserve assessment (biochemical and ovarian dimensions on transvaginal ultrasound); and serum markers of bone turnover (collagen N-terminal telo-peptide, tartrate-resistant acid phosphatase, and bone-specific alkaline phosphatase) and ovarian reserve (FSH, E2, and inhibin B). Multivariable regression analyses determined the associations between VMS, BMD, and bone turnover (individual markers and composite turnover score). Result(s): The prevalence of VMS was 12% in this relatively young population (mean [± SD] age [years], 34.53 ± 4.32). Symptomatic women were statistically significantly more likely to report sleep disturbances and to exhibit evidence of low BMD, as well as to exhibit enhanced bone turnover and poorer ovarian reserve parameters. Multivariable logistic regression analyses confirmed the statistical significance of both HF and NS as independent correlates to low BMD after adjusting for age, body mass index, smoking status, menstrual regularity, and ovarian reserve status. Multivariable linear regression analyses demonstrated that NS, but not HF, predicted higher bone turnover at a statistically significant level after adjusting for age, smoking, menstrual regularity, and ovarian reserve. Conclusion(s): We demonstrate, in a premenopausal population of infertile women, evidence of morbid accompaniments to VMS, including sleep disturbances and evidence of low BMD. Our data further suggest a state of enhanced bone turnover in association with VMS, specifically in those experiencing NS. Declining ovarian reserve may be the common pathophysiological mechanism underlying VMS and low BMD in the symptomatic population and merits further investigation.

Original languageEnglish (US)
Pages (from-to)1626-1634
Number of pages9
JournalFertility and Sterility
Volume90
Issue number5
DOIs
StatePublished - Nov 2008

Fingerprint

Bone Density
Bone Remodeling
Sweat
Hot Flashes
Regression Analysis
Infertility
Population
Sleep
Smoking
Bone and Bones
Alkaline Phosphatase
Ovarian Reserve
Linear Models
Body Mass Index
Collagen
Cross-Sectional Studies
Biomarkers
Logistic Models
Outcome Assessment (Health Care)
Peptides

Keywords

  • BAP
  • bone mineral density
  • bone turnover
  • hot flash
  • night sweats
  • NTX
  • premenopause
  • TRAP
  • Vasomotor symptoms

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Vasomotor symptoms in infertile premenopausal women : a hitherto unappreciated risk for low bone mineral density. / Pal, Lubna; Norian, John; Zeitlian, Gohar; Bevilacqua, Kris; Freeman, Ruth; Santoro, Nanette.

In: Fertility and Sterility, Vol. 90, No. 5, 11.2008, p. 1626-1634.

Research output: Contribution to journalArticle

Pal, Lubna ; Norian, John ; Zeitlian, Gohar ; Bevilacqua, Kris ; Freeman, Ruth ; Santoro, Nanette. / Vasomotor symptoms in infertile premenopausal women : a hitherto unappreciated risk for low bone mineral density. In: Fertility and Sterility. 2008 ; Vol. 90, No. 5. pp. 1626-1634.
@article{c73491ac3f32479891aae45f54b3a45e,
title = "Vasomotor symptoms in infertile premenopausal women: a hitherto unappreciated risk for low bone mineral density",
abstract = "Objective: To identify the prevalence of vasomotor symptoms (VMS) in a population of premenopausal infertile women and to determine whether VMS is associated with enhanced bone turnover and low bone mineral density (BMD). Design: Cross-sectional study. Setting: Academic infertility practice. Patient(s): Eighty-two premenopausal infertile, but otherwise healthy, women attending for routine infertility care. Intervention(s): Bone mineral density testing, general health and Profile of Mood States questionnaires, and serum samples (cycle d 1-3). Main Outcome Measure(s): Vasomotor symptoms, specifically hot flashes (HF) and night sweats (NS); BMD z score, BMD categorized as low (Z ≤ -1.0) or normal (Z > -1.0); ovarian reserve assessment (biochemical and ovarian dimensions on transvaginal ultrasound); and serum markers of bone turnover (collagen N-terminal telo-peptide, tartrate-resistant acid phosphatase, and bone-specific alkaline phosphatase) and ovarian reserve (FSH, E2, and inhibin B). Multivariable regression analyses determined the associations between VMS, BMD, and bone turnover (individual markers and composite turnover score). Result(s): The prevalence of VMS was 12{\%} in this relatively young population (mean [± SD] age [years], 34.53 ± 4.32). Symptomatic women were statistically significantly more likely to report sleep disturbances and to exhibit evidence of low BMD, as well as to exhibit enhanced bone turnover and poorer ovarian reserve parameters. Multivariable logistic regression analyses confirmed the statistical significance of both HF and NS as independent correlates to low BMD after adjusting for age, body mass index, smoking status, menstrual regularity, and ovarian reserve status. Multivariable linear regression analyses demonstrated that NS, but not HF, predicted higher bone turnover at a statistically significant level after adjusting for age, smoking, menstrual regularity, and ovarian reserve. Conclusion(s): We demonstrate, in a premenopausal population of infertile women, evidence of morbid accompaniments to VMS, including sleep disturbances and evidence of low BMD. Our data further suggest a state of enhanced bone turnover in association with VMS, specifically in those experiencing NS. Declining ovarian reserve may be the common pathophysiological mechanism underlying VMS and low BMD in the symptomatic population and merits further investigation.",
keywords = "BAP, bone mineral density, bone turnover, hot flash, night sweats, NTX, premenopause, TRAP, Vasomotor symptoms",
author = "Lubna Pal and John Norian and Gohar Zeitlian and Kris Bevilacqua and Ruth Freeman and Nanette Santoro",
year = "2008",
month = "11",
doi = "10.1016/j.fertnstert.2007.08.020",
language = "English (US)",
volume = "90",
pages = "1626--1634",
journal = "Fertility and Sterility",
issn = "0015-0282",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Vasomotor symptoms in infertile premenopausal women

T2 - a hitherto unappreciated risk for low bone mineral density

AU - Pal, Lubna

AU - Norian, John

AU - Zeitlian, Gohar

AU - Bevilacqua, Kris

AU - Freeman, Ruth

AU - Santoro, Nanette

PY - 2008/11

Y1 - 2008/11

N2 - Objective: To identify the prevalence of vasomotor symptoms (VMS) in a population of premenopausal infertile women and to determine whether VMS is associated with enhanced bone turnover and low bone mineral density (BMD). Design: Cross-sectional study. Setting: Academic infertility practice. Patient(s): Eighty-two premenopausal infertile, but otherwise healthy, women attending for routine infertility care. Intervention(s): Bone mineral density testing, general health and Profile of Mood States questionnaires, and serum samples (cycle d 1-3). Main Outcome Measure(s): Vasomotor symptoms, specifically hot flashes (HF) and night sweats (NS); BMD z score, BMD categorized as low (Z ≤ -1.0) or normal (Z > -1.0); ovarian reserve assessment (biochemical and ovarian dimensions on transvaginal ultrasound); and serum markers of bone turnover (collagen N-terminal telo-peptide, tartrate-resistant acid phosphatase, and bone-specific alkaline phosphatase) and ovarian reserve (FSH, E2, and inhibin B). Multivariable regression analyses determined the associations between VMS, BMD, and bone turnover (individual markers and composite turnover score). Result(s): The prevalence of VMS was 12% in this relatively young population (mean [± SD] age [years], 34.53 ± 4.32). Symptomatic women were statistically significantly more likely to report sleep disturbances and to exhibit evidence of low BMD, as well as to exhibit enhanced bone turnover and poorer ovarian reserve parameters. Multivariable logistic regression analyses confirmed the statistical significance of both HF and NS as independent correlates to low BMD after adjusting for age, body mass index, smoking status, menstrual regularity, and ovarian reserve status. Multivariable linear regression analyses demonstrated that NS, but not HF, predicted higher bone turnover at a statistically significant level after adjusting for age, smoking, menstrual regularity, and ovarian reserve. Conclusion(s): We demonstrate, in a premenopausal population of infertile women, evidence of morbid accompaniments to VMS, including sleep disturbances and evidence of low BMD. Our data further suggest a state of enhanced bone turnover in association with VMS, specifically in those experiencing NS. Declining ovarian reserve may be the common pathophysiological mechanism underlying VMS and low BMD in the symptomatic population and merits further investigation.

AB - Objective: To identify the prevalence of vasomotor symptoms (VMS) in a population of premenopausal infertile women and to determine whether VMS is associated with enhanced bone turnover and low bone mineral density (BMD). Design: Cross-sectional study. Setting: Academic infertility practice. Patient(s): Eighty-two premenopausal infertile, but otherwise healthy, women attending for routine infertility care. Intervention(s): Bone mineral density testing, general health and Profile of Mood States questionnaires, and serum samples (cycle d 1-3). Main Outcome Measure(s): Vasomotor symptoms, specifically hot flashes (HF) and night sweats (NS); BMD z score, BMD categorized as low (Z ≤ -1.0) or normal (Z > -1.0); ovarian reserve assessment (biochemical and ovarian dimensions on transvaginal ultrasound); and serum markers of bone turnover (collagen N-terminal telo-peptide, tartrate-resistant acid phosphatase, and bone-specific alkaline phosphatase) and ovarian reserve (FSH, E2, and inhibin B). Multivariable regression analyses determined the associations between VMS, BMD, and bone turnover (individual markers and composite turnover score). Result(s): The prevalence of VMS was 12% in this relatively young population (mean [± SD] age [years], 34.53 ± 4.32). Symptomatic women were statistically significantly more likely to report sleep disturbances and to exhibit evidence of low BMD, as well as to exhibit enhanced bone turnover and poorer ovarian reserve parameters. Multivariable logistic regression analyses confirmed the statistical significance of both HF and NS as independent correlates to low BMD after adjusting for age, body mass index, smoking status, menstrual regularity, and ovarian reserve status. Multivariable linear regression analyses demonstrated that NS, but not HF, predicted higher bone turnover at a statistically significant level after adjusting for age, smoking, menstrual regularity, and ovarian reserve. Conclusion(s): We demonstrate, in a premenopausal population of infertile women, evidence of morbid accompaniments to VMS, including sleep disturbances and evidence of low BMD. Our data further suggest a state of enhanced bone turnover in association with VMS, specifically in those experiencing NS. Declining ovarian reserve may be the common pathophysiological mechanism underlying VMS and low BMD in the symptomatic population and merits further investigation.

KW - BAP

KW - bone mineral density

KW - bone turnover

KW - hot flash

KW - night sweats

KW - NTX

KW - premenopause

KW - TRAP

KW - Vasomotor symptoms

UR - http://www.scopus.com/inward/record.url?scp=55149120143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55149120143&partnerID=8YFLogxK

U2 - 10.1016/j.fertnstert.2007.08.020

DO - 10.1016/j.fertnstert.2007.08.020

M3 - Article

VL - 90

SP - 1626

EP - 1634

JO - Fertility and Sterility

JF - Fertility and Sterility

SN - 0015-0282

IS - 5

ER -