폐경 전 여성에서 무월경과 골밀도와의 관계
Amenorrhea and Bone Mineral Density in Premenopausal Women
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목적: 무월경을 보이는 폐경 전 여성에서 골밀도 저하의 발생빈도와 무월경 상태에서 골밀도 저하에 영향을 주는 요인, 그리고 심한 골밀도 저하를 일으키는 무월경의 원인을 분석하고자 한다. 방법: 무월경으로 내원한 폐경 전 여성환자 의무기록을 후향적으로 분석하였다. 모든 환자들의 월경력, 무월경 기간 등의 병력을 조사하였고, 이학적 검사와 호르몬 농도와 골밀도 검사 결과를 조사하였다. 무월경의 원인에 따라 4군으로 분류하여 비교 분석하였다. 결과: 171명 연구 대상자들의 평균 나이는 22.8±5.8이었고 골밀도가 감소한 환자는 41.5%의 빈도를 보였다. 골밀도는 통계학적으로 군간 차이를 보였는데 고생식샘자극호르몬생식샘저하증 환자군이 가장 낮은 골밀도를 보였고, 각 질환 별로는 조기난소부전, 신경성 식욕부진이 가장 낮은 골밀도를 보였다. 다중회귀분석에서는 체질량지수, FSH 농도, 에스트라디올 농도가 골밀도에 영향을 주었으며, 무월경의 기간과 골밀도는 약한 음의 상관관계를 나타내었다. 결론: 무월경의 폐경 전 여성에서 낮은 골밀도는 높은 빈도로 발생한다. 무월경 여성 진찰 시 골밀도 검사가 같이 시행되어야 할 것이다.
Abstract
Objectives: This study was designed to investigate the prevalence of low bone mass and to evaluate the influence of amenorrhea on bone mineral density (BMD) in premenopausal women. Methods: One hundred seventy one women diagnosed with amenorrhea in premenopausal women were included in this study. All patients underwent history taking, gynecological examination and check serum hormone level. Dual Energy X-ray Absorptiometry was performed for measurement of BMD. All patients were classified into four groups; hypergonadotrophic hypogonadism, hypogonadotrophic hypogonadism, polycystic ovarian syndrome (PCOS), and control group. Results: The mean age of all patients was 22.8±5.8 years. There were no statistically significant differences among the groups in relation to patient’s age, BMI, TSH level, prolactin level and DHEA sulfate level. But there were statistically significant differences in LH, FSH, estradiol and testosterone level among the groups. T-score in BMD of spine was significantly lower in hypergonadotrophic hypogonadism group than others. Comparing the T-score in BMD according to causes of amenorrhea, premature ovarian failure group and anorexia nervosa group had the lowest bond mass. In the multiple logistic regression model, BMI, FSH and estradiol level were risk factors for low T-score in BMD. There were shown weak negative correlation between duration of amenorrhea and bone mass of spine and femur neck. Conclusion: In this study, there was a high prevalence of low bone mass in adolescent women diagnosed with amenorrhea. BMD should be checked in all adolescent women diagnosed with amenorrhea, especially in hypergonadotrophic hypogonadism and hypogonadotrophic hypogonadism patients.
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