CoChat
Sign Up
Cited by 238Bone health and osteoporosis researchMenopause: Health Impacts and TreatmentsOvarian function and disorders

Bone mineral density in estrogen-deficient young women

Open access
Popat, Vaishali B., Calis, Karim A., Vanderhoof, Vien H., Cizza, Giovanni, Reynolds, James C., Sebring, Nancy, Troendle, James F., Nelson, Lawrence M.·2009·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2008-1878PMC PMC2708959
Open this paper in CoChat — free accountOpen PDF

Abstract

CONTEXT: Osteoporosis primarily affects postmenopausal women. However, young women with estrogen deficiency also are at increased risk for low bone density. OBJECTIVE: The aim of the study was to assess bone density and associated risk factors for reduced bone density in young, estrogen-deficient women using primary ovarian insufficiency (POI) as the disease model. DESIGN AND SETTING: We conducted a cross-sectional study at a tertiary care research center. PARTICIPANTS: We studied women with POI (n = 442), concurrent controls (n = 70), and matched controls from NHANES III (n = 353). PRIMARY OUTCOME MEASURE: We measured bone mineral density (BMD) using dual-energy x-ray absorptiometry. RESULTS: Patients on average had 2-3% lower BMD at L1-L4, femoral neck, and total hip (P < 0.01 at all sites). The modifiable risk factors for BMD below the expected range for age (Z-score <-2) were: more than 1-yr delay in diagnosis of estrogen deficiency (P = 0.018), low (<32 ng/ml) vitamin D levels (P = 0.002), estrogen replacement nonadherence (P = 0.002), low calcium intake (P = 0.005), and lack of exercise (P = 0.005). As compared to Caucasians, African-American and Asian women with POI were 3.18 and 4.34 times more likely, respectively, to have Z-scores below -2 (P = < 0.0001 for both). Race was an overall risk factor, but on regression modeling, not an independent predictor of low bone density. CONCLUSIONS: Women with POI have lower bone density compared to regularly menstruating women. Compared to Caucasians, minority women with estrogen deficiency are more likely to have BMD below the expected range for age. This racial disparity appears to be related to a combined effect of several modifiable risk factors. Delay in diagnosis of POI also contributes to reduced bone density by delaying proper therapy.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1210/jc.2008-1878

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Primary ovarian failure is associated with reduced bone mineral density and increased risk of fractures, and estrogen replacement protects against fractures.

    “Primary ovarian failure is associated with reduced BMD and increased risk of fractures (154-156), and estrogen replacement protects against fractures (154,157,158).”

    From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [157]

    The Abstract and Discussion report that women with primary ovarian insufficiency had lower BMD than controls. The Modifiable risk factors section associates not taking hormone replacement with low BMD, but does not establish protection against fractures. The Discussion says prospective fracture-rate studies are needed to establish the link between estrogen deficiency and fracture risk in this population. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Women with functional hypothalamic amenorrhea are at higher risk of bone stress injuries and may develop premature osteoporosis.

    “Because estrogen is important for bone health, women with functional hypothalamic amenorrhea are at higher risk of bone stress injuries and may even develop premature osteoporosis [15].”

    From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [15]

    The Abstract reports lower bone mineral density in young women with estrogen deficiency, but the study population had primary ovarian insufficiency, not functional hypothalamic amenorrhea. The Discussion links menstrual irregularity to later osteoporosis and fractures; it does not establish an increased risk of bone stress injuries specifically in women with functional hypothalamic amenorrhea. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The literature on primary ovarian failure supports the beneficial effects of estrogen on bone.

    “Nonetheless, the literature on primary ovarian failure supports the beneficial effects of estrogen on bone.”

    From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [157]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Popat, V. B., Calis, K. A., Vanderhoof, V. H., Cizza, G., Reynolds, J. C., Sebring, N., Troendle, J. F., & Nelson, L. M.
Affiliations
National Institutes of Health (US)
Corresponding author
  • Popat, Vaishali B.
  • Nelson, Lawrence M.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2009-07-01
Volume
94
Issue
7
Pages
2277-2283
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2008-1878
PMC
PMC2708959
OpenAlex
W2137272179
Cited by
238
References
32
Citations by year
2026: 15 · 2025: 22 · 2024: 18 · 2023: 31 · 2022: 14 · 2021: 17 · 2020: 19 · 2019: 13 · 2018: 11 · 2017: 14 · 2016: 15 · 2015: 7 · 2014: 9 · 2013: 3 · 2012: 10
FWCI
10.16
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • U.S. Public Health Service
  • National Institute of Child Health and Human Development (-3330)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
bone mineral density, primary ovarian insufficiency, estrogen deficiency, young women, osteoporosis risk factors, vitamin D deficiency, calcium intake, physical inactivity, racial disparities, African American women, Asian women, delayed diagnosis
MeSH terms
Adult, Cross-Sectional Studies, Estrogens, Female, Femur Neck, Hip, Humans, Hypogonadism, Lumbosacral Region, Osteoporosis, Ovarian Diseases, Radiography, Risk Factors, Bone Density, Case-Control Studies, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review