Fracture and Polycystic Ovarian Syndrome in Reproductive-Age Women

Abstract Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in reproductive age women and has been associated with alterations in bone metabolism. However, the clinical impact of PCOS on fracture risk remains unclear, particularly in patients with coexisting uterinefibroids. Methods: We conducted a retrospective cohort study using the Global Collaborative Network database. Women aged 15–45 with both PCOS and uterine fibroids (Cohort 1, n=15,209) were compared to matched controls with fibroids only (Cohort 2, n=15,209). Five fracture sites were analyzed: spine/thoracic/rib, forearm, femur, hip, and humerus. Propensity score matching was performed on baseline characteristics, including BMI, vitamin D deficiency, and tobacco use. Outcomes were assessed through risk analysis, Kaplan-Meier survival, and fracture frequency analysis. Results: Across all fracture sites, absolute event rates were low (0.1–0.3%) and comparable between groups. No statistically significant differences were found in fracture risk, hazard ratios, or mean number of fracture events. The largest numerical difference was observed in femur fractures, where the control group had a higher mean number of events (12.8 vs. 1.6), but this did not reach statistical significance (p = 0.072). All other comparisons showed non-significant differences in both event rates and survival curves. Conclusion: These findings suggest that PCOS does not confer a higher risk of clinical fractures in women with coexisting fibroids. Despite known hormonal and metabolic changes in PCOS that could theoretically impact bone health, this analysis found no increased incidence, earlier onset, or greater frequency of fractures in patients with PCOS. This supports prior mixed evidence indicating that the skeletal effects of PCOS may not translate into higher fracture risk in this population. Future studies incorporating bone mineral density, hormone profiles, and age- and race-stratified data may further clarify fracture risk among PCOS subtypes.