Polycystic ovary syndrome, insulin resistance, and bone health in Saudi women: a cross-sectional study

Insulin resistance is common in Saudi women with PCOS and linked to hormonal imbalances. While bone health differences were not significant, trends suggest obesity and vitamin D may influence future risk. Early detection and management of insulin resistance could help reduce long-term health complications in affected women. BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by hormonal, metabolic, and reproductive dysfunction. Insulin resistance (IR), a hallmark feature of PCOS, is associated with long-term health complications, including adverse effects on bone metabolism. OBJECTIVE: This study aimed to explore the prevalence of IR in Saudi women with PCOS and investigate its associations with hormonal, metabolic, and bone health parameters. METHODS: A cross-sectional study was conducted at the Center of Excellence for Osteoporosis Research, King Abdulaziz University, Jeddah, Saudi Arabia, between December 2018 and June 2019. A total of 144 participants were enrolled, comprising 72 women with PCOS and 72 age- and BMI-matched healthy controls. Anthropometric measurements, biochemical analysis, and bone mineral density (BMD) assessments were performed. IR was evaluated using fasting serum insulin, homeostasis model assessment (HOMA), and glucose-to-insulin ratio (GIR). Statistical analyses included group comparisons and correlation analyses to identify associations. RESULTS: IR was significantly higher in women with PCOS compared to controls across all diagnostic criteria (P < 0.01). PCOS women had higher luteinizing hormone (LH) levels and LH/FSH ratios (P < 0.001), particularly in insulin-resistant subgroups. No significant differences in BMD or T-scores were observed between groups; however, stratified analyses suggested trends toward higher T-scores in obese PCOS women. Vitamin D deficiency was similarly prevalent in both groups. CONCLUSION: This study highlights the substantial metabolic burden of IR in Saudi women with PCOS and its association on hormonal profiles. While no differences in bone health were observed, trends suggest that factors such as BMI and vitamin D status may be associated with skeletal outcomes at later stages. These findings underscore the importance of early IR identification and management to mitigate long-term health complications in PCOS.