{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:02:29Z","timestamp":1790352149756,"version":"4.1.0"},"reference-count":54,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hum Biol"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixty\u2010seven reproductive\u2010aged 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\u2013Wallis tests for non\u2010normally distributed data, and multiple regression analysis was used to examine anthropometrics, lifestyle and reproductive factors, PCOS status, and exercise frequency on fracture occurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fracture occurrence was higher in non\u2010PCOS athletes (3.8\u2009\u00b1\u20094.3) than PCOS\u2010athletes (1.2\u2009\u00b1\u20091.4, <jats:italic>p<\/jats:italic>\u2009=\u2009.11) and PCOS\u2010non\u2010athletes (1.0\u2009\u00b1\u20091.4, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). PCOS\u2010athletes and nonathletes did not differ significantly in fracture occurrence (<jats:italic>p<\/jats:italic>\u2009=\u2009.33). These results were independent of factors associated with bone health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These preliminary findings suggest females with PCOS\u2010related 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajhb.24070","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T06:20:20Z","timestamp":1710570020000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Hyperandrogenism associated with polycystic ovary syndrome may have a protective effect against fracture risk in female athletes: A pilot study"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3924-091X","authenticated-orcid":false,"given":"Courtney","family":"Manthey","sequence":"first","affiliation":[{"name":"The University of Colorado Colorado Springs  Colorado Springs Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4508-8507","authenticated-orcid":false,"given":"Tara","family":"Cepon\u2010Robins","sequence":"additional","affiliation":[{"name":"The University of Colorado Colorado Springs  Colorado Springs Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Warrener","sequence":"additional","affiliation":[{"name":"The University of Colorado Denver  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,15]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/1096-8644(200011)113:3<435::AID-AJPA11>3.0.CO;2-O"},{"key":"e_1_2_13_3_1","first-page":"1544","article-title":"Polycystic ovary syndrome: An ancient disorder?","volume":"5","author":"Azziz R.","year":"2010","journal-title":"Fertility and Sterility"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-4330"},{"key":"e_1_2_13_5_1","first-page":"42","article-title":"Insulin and hyperandrogenism in women with polycystic ovary syndrome","volume":"1","author":"Baptiste C. 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