ArticlePDF Available

Polycystic ovary syndrome: review from a dental perspective

Authors:

Abstract

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries contain many cystic follicles that are associated with chronic anovulation and overproduction of androgens. PCOS is a collection of problems that are found together. Dental diseases and disorders may develop for many reasons. In the past, dental consequences of this condition were typically ignored. In the last years, oral findings and affects of this syndrome have became the subject of various studies. PCOS may affect the composition of the oral microflora, the periodontal health, the dentition with various mechanisms.
REVIEW ARTICLE
POLYCYSTIC OVARY SYNDROME: REVIEW FROM A DENTAL PERSPECTIVE
1Aydın Gülses, 2*Yaşam Kemal Akpak, 3Mustafa Ayna, 4Yahya Açil, 5Nilay Karaca,
6Yasemin Çekmez and Serkan Oral7
1Gülhane Military Medical Academy, Dental Science Center, Ankara, Turkey
2Department of Obstetrics and Gynaecology, Ankara Mevki Military Hospital, Ankara, Turkey
3Private Practice, Duisburg, Germany
4Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany
5Department of Obstetrics and Gynaecology, Bezmialem University, Istanbul, Turkey
6Department of Obstetrics and Gynaecology, Ümraniye Education and Research Hospital, Istanbul, Turkey
7Department of Assisted Reproduction, LIV Hospital, Istanbul, Turkey
ARTICLE INFO ABSTRACT
Polycystic ovary syndrome (PCOS) is a condition in which the ovaries contain many cystic follicles
that are associated with chronic anovulation and overproduction of androgens. PCOS is a collection of
problems that are found together. Dental diseases and disorders may develop for many reasons. In the
past, dental consequences of this condition were typically ignored. In the last years, oral findings and
affects of this syndrome have became the subject of various studies. PCOS may affect the composition
of the oral microflora, the periodontal health, the dentition with various mechanisms.
Copyright © 2016 Aydın Gülses et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
INTRODUCTION
Polycystic ovary syndrome (PCOS) which is characterized by
chronic anovulation, hyperandrogenism, and polycystic ovary,
is the most common endocrine disorder, affecting women of
reproductive age with the prevalence ranging from 6.5% to 8%
(Spritzer and Motta, 2015). Potential metabolic risk factors
associated with this syndrome are: insulin-dependent diabetes,
dyslipidemia, visceral obesity, endothelial dysfunction and
chronic low grade inflammation (Hsu, 2015). It has been
stated that certain pro-inflammatory cytokines, such as
interleukin-6 (IL-6), interleukin-17 (IL-17), tumor necrosis
factor-a (TNF- a) were elevated in women with PCOS which
are responsible for chronic low-grade inflammation (Ebejer
and Calleja-Agius, 2013). Nevertheless, there is still limited
information about the composition of dentition, the periodontal
health, the oral microbiota, with regards to systemic
inflammatory conditions caused by PCOS. The aim of this
paper was to review the literature by analyzing the published
manuscripts focusing on the oral aspects of PCOS.
*Corresponding author: Yaşam Kemal Akpak
Department of Obstetrics and Gynaecology, Ankara Mevki Military
Hospital, Ankara, Turkey
The effects of PCOS on the oral microbiota
Akcali et al. (2014) have evaluated the levels of putative
periodontal pathogens in saliva and their antibody response in
serum in PCOS patients in comparison with healthy subjects
by using real-time polymerase chain reaction and analyzing
serum antibody levels via ELISA. According to their findings,
in women with PCOS, salivary Porphyromonas gingivalis (P.
Gingivalis), Fusobacterium nucleatum (F. Nucleatum),
Streptococcus oralis and Tannerella forsythia levels were
higher than matched systemically healthy women.
Aggregatibacter actinomycetemcomitans and Treponema
denticola levels were similar among study groups. The
presence of PCOS also enhanced P. gingivalis, Prevotella
intermedia and S. oralis serum antibody levels. Gingival
inflammation correlated positively with levels of the studied
taxa in saliva, particularly in PCOS. The presence of P.
gingivalis and F. nucleatum in saliva also exhibited a strong
positive correlation with the corresponding serum antibody
levels. They have proclaimed that PCOS may quantitatively
affect the composition of oral microbiota and the raised
systemic response to selective members of this microbial
community, exerting a confounding role in resultant gingival
inflammation and periodontal health.
ISSN: 0976-3376
Asian Journal of Science and Technology
Vol.07, Issue, 01, pp.2227-2229, January, 2016
Available Online at http://www.journalajst.com
ASIAN JOURNAL OF
SCIENCE AND TECHNOLOGY
Article History:
Received 07th October, 2015
Received in revised form
14th November, 2015
Accepted 20th December, 2015
Published online 31
st
January, 2016
Key words:
Dentition, Gingivitis,
Oral Diagnosis,
Periodontal Health,
Polycystic Ovary Syndrome.
The effects of PCOS on the periodontal health
Gingivitis is a low-grade inflammatory pathology seen in
patients with PCOS (Dursun et al., 2011). In 2011, Dursun et
al. (2011) have first examined the periodontal status in PCOS,
suggested that the susceptibility for periodontal disease may
significantly increase in patients with PCOS compared with
healthy young women, and that local/periodontal oxidant
status appears to be affected in PCOS. Özçaka et al. have
investigated the gingival crevicular fluid (GCF), saliva, and
serum concentrations of tumor necrosis factor-α (TNF-α),
TNF-α receptor-1 (TNF-αR1), TNF-αR2, and IL-6 in non-
obese females with PCOS and either clinically healthy
periodontium or gingivitis. According to their results, PCOS
and gingival inflammation appear to act synergistically on the
pro-inflammatory cytokines IL-6 and TNF-α and PCOS may
have an impact on gingival inflammation or vice versa
(Özçaka et al., 2012). In a similar study performed by the
same authors in 2013, interleukin-17A (IL-17A), IL-17F, IL-
17A/F, and IL-17E (IL-25) levels in GCF, saliva, and serum of
non-obese females with PCOS and with either a clinically
healthy periodontium or gingivitis were evaluated. They have
found that IL-17 levels are altered in non-obese females with
PCOS and may influence gingival inflammation (Özçaka et
al., 2013).
Porwal et al. (2014) have investigated the periodontal status
and systemic inflammation of women receiving medical
treatment for PCOS and women newly diagnosed with PCOS
according to periodontal parameters, anthropometric
parameters, and serum levels of high-sensitivity C-reactive
protein (hsCRP) levels. The authors have stated that women
with newly diagnosed PCOS may have increased prevalence
and likelihood for periodontitis, with higher measures of
periodontal inflammation and breakdown than those on
medical treatment for PCOS and systemically healthy females.
Akcali et al. (2014) have evaluated the levels of matrix
metalloproteinase-8 (MMP-8) and tissue inhibitors of MMP-1
(TIMP-1) in saliva and serum samples of women with PCOS
in comparison with systemically healthy controls. They have
found significantly elevated salivary levels of MMP-8 and the
MMP-8/TIMP-1 ratio in women with PCOS, who also
exhibited more gingivitis than systemically healthy women.
Salivary TIMP-1 levels showed no major changes with regard
to PCOS. In addition, positive correlation was found between
probing depth, bleeding on probing, plaque index and salivary
or serum MMP-8 levels or MMP-8/TIMP-1 ratio in the case of
PCOS, while a negative such correlation was revealed for
TIMP-1 in systemically healthy women. They have
proclaimed that changes in MMP/TIMP system triggered by
local and systemic inflammation may be implicated in the
pathogenesis of PCOS, or the deterioration of its clinical
presentation.
In an interesting case report, Asnani et al. (2014) presented a
case of a patient with PCOS, who is suffering from gingival
swelling and spontaneous bleeding that persisted for more than
two months. The authors have taken a gingival biopsy sample
and compared it with another patient who had the same health
condition but did not show any gingival enlargement. Testing
of tissue samples for oestrogen and progesterone receptors
showed the first patient to be positive for oestrogen receptors
but negative for progesterone, whereas the control was
negative for both. They have emphasized the effects of
oestrogen receptors in PCOS patients on periodontium.
The effects of PCOS on dentition
In 1997, Hattab and Angmar Mansson (1997) have reported
the cases of two sisters, aged 18 and 21, who collectively had
congenitally missing permanent teeth. Both patients exhibited
with PCOS, which is not previously linked to hypodontia. In
the first case, intraoral photograph oligodontia of all
permanent teeth, except the upper central incisors were
present. In the second case, intraoral examination revealed that
only six of the permanent teeth were erupted (the maxillary
right first premolar, maxillary central incisors, mandibular left
first molar, mandibular right canine, and second molar). The
authors have added oligodontia as one of the findings of PCOS
to the literature.
Others
Yanazume et al., (2010) have stated that in PCOS women,
trunk fat mass, despite being smaller, influences bone mineral
density more than peripheral fat mass does. This effect was
attributed by the authors to the inducement by non-weight-
bearing effects of trunk fat mass. Considering the amount of
need for dental implant therapy nowadays, further studies are
also necessary and warranted to investigate the changes of the
bone quality/quantity in the maxillofacial region in PCOS
patients.
Conclusion
The studies presented herein collectively suggest that patients
with PCOS have altered circulatory levels of some markers of
inflammation, which may reflect a state of chronic low grade
gingival inflammation. However, long term implications of
these findings remain to be confirmed. In addition, future
studies in this field should define the clinically relevant
therapy options, rather than comparison of means and changes
in biomarkers and their correlation with periodontal health
status.
Acknowledgments: None
Conflict of Interest: The authors declare that they have no
conflict of interest. We certify that we had no relationship with
companies that may have a financial interest.
REFERENCES
Akcalı, A., Bostanci, N., Özçaka, Ö., et al. 2014. Association
between polycystic ovary syndrome, oral microbiota and
systemic antibody responses. PLoS One, 9: e108074.
Asnani, K.P., Hingorani, D., Kheur, S. et al. 2014. Expression
of nuclear receptors of gingiva in polycystic ovarian
syndrome: a preliminary case study. Aust Dent J, 59: 252-
257.
Dursun, E., Akalın, F.A., Güncü, G.N., et al. 2011. Periodontal
disease in polycystic ovary syndrome. Fertil Steril, 95:
320-323.
Ebejer, K. and Calleja-Agius, J. 2013. The role of cytokines in
polycystic ovarian syndrome. Gynecol Endocrinol, 29:
536-540.
2228 Asian Journal of Science and Technology Vol.07, Issue, 01, pp. 2227-2229, January,
2016
Hattab, F.N. and Angmar-Månsson, B. 1997. Oligodontia of
the permanent dentition in two sisters with polycystic
ovarian syndrome: case reports. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod, 84: 368-371.
Hsu, M.I. 2013. Changes in the PCOS phenotype with age.
Steroids, 78: 761-766.
Özçaka, Ö., Buduneli, N., Ceyhan, B.O., et al. Is interleukin-
17 involved in the interaction between polycystic ovary
syndrome and gingival inflammation? J. Periodontol, 84:
1827-1837.
Özçaka, Ö., Ceyhan, B.Ö., Akcali, A., et al. 2012. Is there an
interaction between polycystic ovary syndrome and
gingival inflammation? J. Periodontol, 83: 1529-1537.
Porwal, S., Tewari, S., Sharma, R.K., et al. 2014. Periodontal
status and high-sensitivity C-reactive protein levels in
polycystic ovary syndrome with and without medical
treatment. J Periodontol, 85: 1380-1389.
Spritzer, P.M. and Motta, A.B. 2015. Adolescence and
polycystic ovary syndrome: current concepts on diagnosis
and treatment. Int. J. Clin. Pract., 69:1236-1246.
Yanazume, Y., Kawamura, Y., Kuwahata, A., et al. 2010.
Difference in non-weight-bearing effects on bone mineral
density between trunk and peripheral fat mass in women
with polycystic ovary syndrome. J Obstet Gynaecol Res,
36: 352-356.
*******
2229 Asian Journal of Science and Technology Vol.07, Issue, 01, pp. 2227-2229, January,
2016
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Article
Polycystic ovary syndrome (PCOS) is a hormonal disorder of women that not only is the leading cause of infertility but also shows a reciprocal link with oral health. This study aimed to investigate the hypothesis that the levels of putative periodontal pathogens in saliva and their antibody response in serum are elevated in PCOS, compared to systemic health. A total of 125 women were included in four groups; 45 women with PCOS and healthy periodontium, 35 women with PCOS and gingivitis, 25 systemically and periodontally healthy women, 20 systemically healthy women with gingivitis. Salivary levels of seven putative periodontal pathogens were analyzed by quantitative real-time polymerase chain reaction and serum antibody levels were analyzed by ELISA. In women with PCOS, salivary Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus oralis and Tannerella forsythia levels were higher than matched systemically healthy women, particularly in the case of gingivitis. Aggregatibacter actinomycetemcomitans and Treponema denticola levels were similar among study groups. The presence of PCOS also enhanced P. gingivalis, Prevotella intermedia and S. oralis serum antibody levels, when gingivitis was also present. Gingival inflammation correlated positively with levels of the studied taxa in saliva, particularly in PCOS. The presence of P. gingivalis and F. nucleatum in saliva also exhibited a strong positive correlation with the corresponding serum antibody levels. In conclusion, as an underlying systemic endocrine condition, PCOS may quantitatively affect the composition of oral microbiota and the raised systemic response to selective members of this microbial community, exerting a confounding role in resultant gingival inflammation and periodontal health. The most consistent effect appeared to be exerted on P. gingivalis.
Full-text available
Article
Oestrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In females, during puberty, ovulation and pregnancy, there is an increase in the production of sex steroid hormones, which results in increased gingival inflammation, characterized by gingival enlargement, increased bleeding and crevicular fluid flow. This article presents a case of a patient who presented with a complaint of gingival swelling and spontaneous bleeding that persisted for more than two months. Her health history documented the recently diagnosed presence of polycystic ovarian syndrome. Clinical examination revealed enlarged painful gingival tissues, which bled when touched. After completion of Phase I therapy, the enlargement did not subside and a biopsy sample was taken. This was compared with another patient who had the same health condition but did not show any gingival enlargement. Testing of tissue samples for oestrogen and progesterone receptors showed the first patient to be positive for oestrogen receptors but negative for progesterone, whereas the control was negative for both. Positive oestrogen receptors suggest that polycystic ovarian syndrome has some effect on the periodontium. The dental consequences of this condition, highly prevalent among young females, are typically ignored. Further studies warrant establishment of a clinical association and future diagnosis.
Full-text available
Article
Background: Polycystic ovarian syndrome (PCOS) is a hormonal disorder of females of reproductive age that impacts their oral and systemic health. The aim of this study is to evaluate interleukin-17A (IL-17A), IL-17F, IL-17A/F, and IL-17E (IL-25) levels in gingival crevicular fluid (GCF), saliva, and serum of non-obese females with PCOS and with either a clinically healthy periodontium or gingivitis. Methods: Thirty-one females with PCOS, 30 females with PCOS and gingivitis, and 12 systemically and periodontally healthy females participated in the study. Clinical periodontal measurements, body mass index, and Ferriman-Gallwey score (FGS) (a measure of hirsutism in females) were recorded. Circulating levels of sex hormones, cortisol, and insulin were also determined. Levels of IL-17 cytokines were measured by enzyme-linked immunosorbent assay. Results: The general linear model multivariate analysis, adjusting for age or plaque index, showed that the two groups with PCOS had higher concentrations of IL-17A, IL-17F, and IL-17A/F in serum and higher levels of IL-17A and IL-17F in GCF and saliva but lower serum IL-17E than systemically healthy females. Levels of IL-17E were lowest in females with PCOS and gingivitis who also had the highest FGS. Serum IL-17A and IL-17F levels correlated positively with FGS and periodontal probing depth (all ρ >0.33; P <0.005). Serum IL-17E showed the reverse relationship and also correlated negatively with IL-17A (ρ >-0.28; P <0.05). Conclusions: IL-17 levels are altered in non-obese females with PCOS and may influence gingival inflammation. Additional studies are warranted to clarify the relationship between PCOS and gingivitis.
Full-text available
Article
Background: The aim of this study is to evaluate the gingival crevicular fluid (GCF), saliva, and serum concentrations of tumor necrosis factor-α (TNF-α), TNF-α receptor-1 (TNF-αR1), TNF-αR2, and interleukin-6 (IL-6) in non-obese females with polycystic ovary syndrome (PCOS) and either clinically healthy periodontium or gingivitis. Methods: Thirty-one females with PCOS and healthy periodontium, 30 females with PCOS and gingivitis, and 12 systemically and periodontally healthy females were included in the study. GCF, saliva, and serum samples were collected, and clinical periodontal measurements, body mass index, and Ferriman-Gallwey score (FGS) were recorded. Sex hormones, cortisol, and insulin levels were measured. TNF-α, TNF-αR1, TNF-αR2, and IL-6 were determined by enzyme-linked immunosorbent assay. Kruskal-Wallis followed by Bonferroni-corrected post hoc Mann-Whitney U tests were used to analyze the data. Results: The PCOS + gingivitis group revealed significantly higher GCF, saliva, and serum IL-6 concentrations than the PCOS + healthy group (P <0.0001). The two PCOS groups exhibited significantly higher saliva TNF-α concentrations than the control group (P = 0.024 and P = 0.013, respectively). The FGS index was significantly higher in the PCOS + gingivitis group than the PCOS + healthy group (P = 0.030). The PCOS + gingivitis group revealed significantly higher insulin concentration than the PCOS + healthy and control groups (P = 0.014 and P <0.0001, respectively). Serum TNF-α, TNF-αRs, and serum, GCF, and salivary IL-6 levels correlated with the clinical periodontal measurements. Conclusions: PCOS and gingival inflammation appear to act synergistically on the proinflammatory cytokines IL-6 and TNF-α. Thus, PCOS may have an impact on gingival inflammation or vice versa. Additional studies are warranted to clarify the possible relationship between PCOS and periodontal disease.
Article
Background Adolescence is a time characterised by changes in reproductive hormones and menstrual patterns, which makes it difficult to diagnose polycystic ovary syndrome (PCOS) in this population. The diagnosis of PCOS has a great physical and psychosocial impact on the young person. Despite the importance of a diagnosis of PCOS at adolescence, data available are limited.AimsThis review focuses on analysing markers of PCOS diagnosis and possible treatments in adolescence.ResultsAlthough, during adolescence, diagnosis criteria of PCOS overlap with physiological changes including clinical manifestations of hyperandrogenism (acne and hirsutism), oligo/amenorrhoea, anovulation and ovarian microcysts, there is agreement that irregular menses and hyperandrogenaemia should be used to diagnose PCOS in this population. Moreover, considering that PCOS phenotype could change through the reproductive age and that adolescents display heterogeneous ovarian morphology, it has been proposed that diagnosis of PCOS should be confirmed after the age of 18. The first-line treatment for menstrual irregularity and hirsutism are oral contraceptive pills (OCPs) and for obesity and metabolic abnormalities are lifestyle changes. Insulin-sensitizer drugs, such as metformin, may be added to the treatment in the presence of metabolic alterations. Antiandrogen drugs may also be associated for treating moderate to severe hirsutism.During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include lifestyle changes. Pharmacological treatments comprise OCPs, antiandrogens and metformin, used isolated or combined.Conclusions During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include lifestyle changes. Pharmacological treatments comprise OCPs, antiandrogens and metformin, used isolated or combined.
Article
Background: Recently, some studies have revealed the effect of polycystic ovary syndrome (PCOS) on gingival inflammation. This cross-sectional study attempts to assess the periodontal status and systemic inflammation of women receiving medical treatment for PCOS and women newly diagnosed with PCOS. Methods: A total of 126 participants comprising 41 newly diagnosed patients with PCOS (PCOS-N), 45 patients with PCOS on medical treatment (PCOS-MT), and 40 systemically healthy controls (control group [CG]) were examined. Periodontal parameters, anthropometric parameters, and serum levels of high-sensitivity C-reactive protein (hsCRP) were recorded. Results: Women with newly diagnosed PCOS had increased sites with bleeding on probing (BOP), probing depth, clinical attachment level (CAL), waist circumference (WC), hsCRP, and prevalence of periodontitis compared with control and PCOS-MT groups (P ≤0.05). On partial correlation analysis after controlling for confounders, BOP and CAL correlated positively and significantly with hsCRP (P = 0.01 and P = 0.005). Multivariate linear regression analysis revealed that BOP and CAL (dependent variable) (P = 0.009/R(2) = 0.05 and P = 0.005/R(2) = 0.07, respectively) had significant association with hsCRP. Furthermore, hsCRP, when considered as outcome, also exhibited association with CAL and WC (P = 0.002/R(2) = 0.07 and P = 0.04/R(2) = 0.106). Logistic regression analysis demonstrated that the PCOS-N group had 2.88 times increased likelihood of having moderate periodontitis (adjusted odds ratio 2.88, 95% confidence interval 1.18 to 6.98). Conclusions: Women with newly diagnosed PCOS may have increased prevalence and likelihood for periodontitis, with higher measures of periodontal inflammation and breakdown than those on medical treatment for PCOS and systemically healthy females. Furthermore, periodontal breakdown might depend on systemic inflammation and vice versa.
Article
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women. The diagnosis of PCOS is mainly based on the following three components: (1) hyperandrogenism, (2) oligo-amenorrhea, and (3) the observation of polycystic ovaries on a sonogram. The comorbidities may include insulin resistance, type II diabetes mellitus, hypertension and cardiovascular disease. Importantly, the diagnostic criteria and complications related to PCOS are age-dependent. Androgen production in women may decrease because of ovarian aging or decreased production by the adrenal glands over time. The prevalence of hirsutism and acne decreases with age. Ovarian volume and follicle number also decrease with age, with the age-related decrease in follicle number seemingly greater than that of ovarian volume. Aging may also be associated with increased risk of insulin resistance and metabolic disturbances. Therefore, these age-related changes may affect the observed incidence and complications of PCOS. In adolescent patients, the criteria described above pose particular diagnostic problems because the characteristics of normal puberty often overlap with the signs and symptoms of PCOS. Hyperandrogenism and chronic anovulation are the primary disturbances in younger women with PCOS; whereas, obesity, insulin resistance, and metabolic disturbances are predominant in older women with PCOS. The deterioration of insulin resistance during the reproductive life of women with PCOS appears to be mainly attributable to the increase in obesity. Therefore, if body weight could be controlled properly, younger hyperandrogenic PCOS women might reduce their risk of insulin resistance and metabolic disturbances later in life.
Article
Abstract Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Inflammation has been implicated in the metabolic disturbances and menstrual irregularities, which characterize this condition. Various inflammatory proteins have been investigated in women with PCOS including C-reactive protein, interleukin-6, interleukin-18 and tumor necrosis factor-alpha. The data is suggestive of the presence of a chronic low-grade inflammatory state, especially in case of obesity, insulin resistance and hyperandrogenism. Targeting this inflammatory process by means of anti-inflammatory agents might be a therapeutic alternative to the current treatment.
Article
Polycystic ovary syndrome (PCOS) and periodontal disease (inflammatory diseases of the tissues around teeth) are common disorders associated with diabetes and cardiometabolic risk. Comprehensively examining the periodontal status in PCOS, this study suggests that the susceptibility for periodontal disease may significantly increase in patients with PCOS compared with healthy young women, and that local/periodontal oxidant status appears to be affected in PCOS. (Fertil Steril (R) 2011; 95:320-3. (c) 2011 by American Society for Reproductive Medicine.)
Article
To investigate the difference in non-weight-bearing effects on bone mineral density (BMD) between trunk and peripheral fat mass in women with polycystic ovary syndrome (PCOS). Subjects were 123 amenorrheic PCOS women with right side dominance. Age, height, body weight, and body mass index were recorded. Trunk, peripheral (extremities), trunk-leg fat ratio as an index of body fat distribution, left arm (non-weight-bearing site) lean mass and BMD were measured by dual-energy X-ray absorptiometry. Serum testosterone and estradiol levels were measured. Relationships of BMD with trunk, peripheral fat mass, and sex hormones levels were investigated. Trunk fat mass amount was 9.8 + or - 6.7 kg and was lower than the peripheral fat mass amount (12.2 + or - 4.4 kg, P < 0.01). On Pearson's correlation test, trunk fat mass and left arm lean mass were positively correlated with arm BMD (r = 0.359, P < 0.001 and r = 0.501, P < 0.0001, respectively), while peripheral fat mass and serum testosterone levels were not correlated with BMD (r = 0.083 and 0.114, respectively, NS). On multiple regression analysis, trunk fat mass was positively correlated with BMD (t-value = 3.465; P < 0.001), independent of age and height. However, this relationship disappeared after additionally adjusting for left arm lean mass. Trunk fat mass, despite the smaller amount, is more associated with arm BMD than peripheral fat mass is through its non-weight-bearing effects.