The University of Colorado Colorado Springs, Colorado Springs, Colorado, USA.
The University of Colorado Denver, Denver, Colorado, USA.
Am J Hum Biol. 2024 Aug;36(8):e24070. doi: 10.1002/ajhb.24070. Epub 2024 Mar 15.
Polycystic ovary syndrome (PCOS), characterized by polycystic ovaries, anovulation, and hyperandrogenism, is believed to be an evolutionary mismatch disease. Past research has examined PCOS as a uniform disease, despite variation in phenotypes across diagnostic categories, but establishing an evolutionary mismatch requires a focus on individual traits. We suggest PCOS hyperandrogenism may have been beneficial in ancestral environments because it reduced fracture risk and associated morbidity and mortality due to increased bone mineral density (BMD). We test this hypothesis by assessing fracture frequency, a proxy for BMD, in highly active females with and without PCOS hyperandrogenism.
Sixty-seven reproductive-aged women were surveyed and grouped as: high intensity interval training (HIIT; a proxy for metabolic and physical stress) athletes with hyperandrogenic PCOS (31.24%), HIIT athletes without PCOS (29.85%), and nonathletes with hyperandrogenic PCOS (38.81%). Fracture occurrence was compared between the groups using independent samples Kruskal-Wallis tests for non-normally distributed data, and multiple regression analysis was used to examine anthropometrics, lifestyle and reproductive factors, PCOS status, and exercise frequency on fracture occurrence.
Fracture occurrence was higher in non-PCOS athletes (3.8 ± 4.3) than PCOS-athletes (1.2 ± 1.4, p = .11) and PCOS-non-athletes (1.0 ± 1.4, p < .01). PCOS-athletes and nonathletes did not differ significantly in fracture occurrence (p = .33). These results were independent of factors associated with bone health.
These preliminary findings suggest females with PCOS-related hyperandrogenism may be less likely to experience bone fractures and provide an initial step to explaining why PCOS has persisted despite marked negative reproductive consequences in modern populations.
多囊卵巢综合征（PCOS）的特征是多囊卵巢、排卵障碍和高雄激素血症，被认为是一种进化不匹配疾病。过去的研究将 PCOS 视为一种单一的疾病，尽管在不同的诊断类别中存在表型差异，但要确定进化不匹配，就需要关注个体特征。我们提出，PCOS 高雄激素血症在远古环境中可能是有益的，因为它通过增加骨密度（BMD）降低了骨折风险和相关发病率和死亡率。我们通过评估高度活跃的有和无 PCOS 高雄激素血症的女性的骨折频率（BMD 的替代指标）来检验这一假设。
对 67 名育龄妇女进行了调查，并分为以下三组：有高雄激素血症的高强度间歇训练（HIIT；代谢和身体压力的替代指标）运动员（31.24%）、无 PCOS 的 HIIT 运动员（29.85%）和有高雄激素血症的非运动员（38.81%）。使用独立样本 Kruskal-Wallis 检验对非正态分布数据进行组间比较，使用多元回归分析检验身体测量、生活方式和生殖因素、PCOS 状态和运动频率对骨折发生的影响。
非 PCOS 运动员的骨折发生率（3.8±4.3）高于 PCOS 运动员（1.2±1.4，p=0.11）和 PCOS 非运动员（1.0±1.4，p<0.01）。PCOS 运动员和非运动员的骨折发生率无显著差异（p=0.33）。这些结果与与骨骼健康相关的因素无关。
这些初步发现表明，与 PCOS 相关的高雄激素血症的女性可能不太容易发生骨折，并为解释为什么尽管在现代人群中 PCOS 导致了明显的负面生殖后果，但它仍能持续存在提供了初步步骤。
