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Fracture Incidence in Women with Polycystic Ovarian Syndrome: A Retrospective Cohort Analysis
Journal article   Open access   Peer reviewed

Fracture Incidence in Women with Polycystic Ovarian Syndrome: A Retrospective Cohort Analysis

Tanya Li, Wali U Pirzada, Ameera Zaynab Syed, Simran Fathima Shamith, Kimberly Dong, Asif M Ilyas and Meghan E. Bishop
Journal of clinical orthopaedics and trauma, 103433
Apr 2026
DOI: https://doi.org/10.1016/j.jcot.2026.103433
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https://doi.org/10.1016/j.jcot.2026.103433View
Published, Version of Record (VoR) Open Access via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0

Abstract

Bone Density Fractures Polycystic Ovary Syndrome Bone
Background Polycystic Ovarian Syndrome (PCOS) impacts reproductive-age women through metabolic disturbances and hormone imbalances. These changes have been linked to bone health, but the association between PCOS and incidence of fractures remains unclear. Clarifying the link between PCOS and fractures is important to guide clinical care and develop prevention strategies. Methods A retrospective cohort analysis using the TriNetX research platform evaluated fracture incidence in female patients with and without PCOS. The study assessed the occurrence of distal radius, femoral neck, ankle, and metatarsal fractures, identified through ICD-10 codes. Fracture incidence was measured from one day following PCOS diagnosis to the most recent available encounter. Analysis was performed after propensity score matching, with statistical significance defined as a p-value of <0.05. Results Final analysis included 174,937 patients in both cohorts. Incidence rates of distal radius, femoral neck, and metatarsal fractures were significantly reduced in patients with PCOS, with risk ratios of 0.7 (CI: 0.613-0.8), 0.647 (CI: 0.521-0.804), and 0.913 (CI: 0.834-0.998), respectively. Although the incidence rate of ankle fractures was also reduced in the PCOS cohort, this finding was not statistically significant (RR: 0.921, CI: 0.836-1.015). Conclusion The results of this study show that patients with PCOS have lower distal radius, femoral neck, and metatarsal fracture rates compared to patients without PCOS. These findings suggest PCOS is not related to an increase in the risk of fractures. Further investigation is needed to better understand this potentially fracture-protective effect across different bone sites.

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