Fracture Risk After Bilateral Oophorectomy in Elderly Women

Department of Internal Medicine, Mayo Clinic - Rochester, Рочестер, Minnesota, United States
Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research (Impact Factor: 6.59). 04/2003; 18(5):900 - 905. DOI: 10.1359/jbmr.2003.18.5.900

ABSTRACT Elderly women with the lowest serum estrogen levels are at the greatest risk of bone loss and fractures, but it is controversial whether the ovaries contribute to estrogen production after menopause, and therefore, whether bilateral oophorectomy in postmenopausal women might have adverse skeletal effects. To address this potential problem, we estimated long-term fracture risk among 340 postmenopausal Olmsted County, MN, women who underwent bilateral oophorectomy for a benign ovarian condition in 1950-1987. In over 5632 person-years of follow-up (median, 16 years per subject), 194 women experienced 516 fractures (72% from moderate trauma). Compared with expected rates, there was a significant increase in the risk of any osteoporotic fracture (moderate trauma fractures of the hip, spine, or distal forearm; standardized incidence ratio [SIR], 1.54; 95% CI, 1.29-1.82) but almost as large an increase in fractures at other sites (SIR, 1.35; 95% CI, 1.13-1.59). In multivariate analyses, the independent predictors of overall fracture risk were age, anticonvulsant or anticoagulant use for ≥6 months, and a history of alcoholism or prior osteoporotic fracture; obesity was protective. Estrogen replacement therapy was associated with a 10% reduction in overall fracture risk (hazard ratio [HR], 0.90; 95% CI, 0.64-1.28) and a 20% reduction in osteoporotic fractures (HR, 0.80; 95% CI, 0.52-1.23), but neither was statistically significant. The increase in fracture risk among women who underwent bilateral oophorectomy after natural menopause is consistent with the hypothesis that androgens produced by the postmenopausal ovary are important for endogenous estrogen production that protects against fractures.

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    • "The attention to blood supply when adding bilateral salpingectomy to TLH may explain our positive results in terms of post-operative ovarian function, since an intact blood flow is essential to a normal ovarian steroid hormone synthesis. Preservation of the ovarian function is important both in the pre-menopausal age and in the post-menopause, due to the effective prevention of bone resorption, guaranteed by the intact ovaries [15] [16] [17]. Furthermore, surgical menopause increases long-term risk of psychosexual, cognitive and cardiovascular dysfunctions [18] [19] [20] and incidence of fatal and non-fatal coronary heart diseases [21]. "
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    ABSTRACT: OBJECTIVE: The objective of this study is to compare ovarian function and surgical outcomes between patients affected by benign uterine pathologies submitted to total laparoscopic hysterectomy (TLH) plus salpingectomy and women in which standard TLH with adnexal preservation was performed. METHODS: We retrospectively compared data of 79 patients who underwent TLH plus bilateral salpingectomy (group A), with those of 79 women treated by standard TLH without adnexectomy (sTLH) (group B). Ovarian reserve modification, expressed as the difference between 3 months post-operative and pre-operative values of Anti-Müllerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Antral Follicle Count (AFC), mean ovarian diameters and Peak Systolic Velocity (PSV), was recorded for each patient. For each surgical procedure, operative time, variation of hemoglobin level (ΔHb), postoperative hospital stay, postoperative return to normal activity, and complication rate were recorded as secondary outcomes. RESULTS: According to our post-hoc analysis, this equivalence study resulted to have a statistical power of 96,8%. Significant difference was not observed between groups with respect to ΔAMH (p=0.35), ΔFSH (p=0.15), ΔAFC (p=0.09), Δ mean ovarian diameters (p=0.57) and ΔPSV (p=0.61). In addition, secondary outcomes such as operative time (p=0.79), ΔHb (p=0.41), postoperative hospital stay (p=0.16), postoperative return to normal activity (p=0.11) and complication rate also did not show any significant difference. CONCLUSIONS: The addition of bilateral salpingectomy to TLH for prevention of ovarian cancer in women who do not carry a BRCA1/2 mutations do not show negative effects on the ovarian function. In addition, no perioperative complications are related to the salpingectomy step in TLH.
    Gynecologic Oncology 04/2013; 129(3). DOI:10.1016/j.ygyno.2013.03.023 · 3.69 Impact Factor
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    ABSTRACT: To review the risks and benefits of elective oophorectomy and to make a clinical recommendation for an appropriate age when benefits of this procedure outweigh the risks. The risks and benefits of oophorectomy as detailed in published articles are reviewed with regard to quality-of-life issues and mortality outcomes in oophorectomized versus non-oophorectomized women from five diseases linked to ovarian hormones (coronary heart disease, ovarian cancer, breast cancer, stroke, and hip fracture). Numerous reports link oophorectomy to higher rates of cardiovascular disease, osteoporosis, hip fractures, dementia, short-term memory impairment, decline in sexual function, decreased positive psychological well-being, adverse skin and body composition changes, and adverse ocular changes, as well as more severe hot flushes and urogenital atrophy. The potential benefits associated with oophorectomy include prevention of ovarian cancer, a decline in breast cancer risk, and a reduced risk of pelvic pain and subsequent ovarian surgery. In our study of long-term mortality after oophorectomy using Markov modeling, preservation of ovaries until women are at least aged 65 years was associated with higher survival rates. For women between ages 50 and 54 with hysterectomy and ovarian preservation, the probability of surviving to age 80 was 62% versus 54% if oophorectomy was performed. This 8% difference in survival is primarily due to fewer women dying from cardiovascular heart disease and/or hip fracture. This survival advantage far outweighs the 0.47% increased mortality rate from ovarian cancer prevented by oophorectomy. If surgery occurred between ages 55 and 59, the survival advantage was 4%. After age 64 there were no significant differences in survival rates. Prior literature supports our conclusion of a benefit over risk for ovarian conservation. Elective oophorectomy is associated with short-and long-term health consequences that merit serious consideration. For women with an average risk of ovarian cancer, ovarian conservation until at least age 65 seems to benefit long-term survival.
    Menopause 01/2007; 14(3 Pt 2):580-5. DOI:10.1097/gme.0b013e31803c56a4 · 2.81 Impact Factor
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    ABSTRACT: There is a widespread tendency to perform oophorectomy at the same time as hysterectomy, based on the view that prophylactic oophorectomy is the best strategy to reduce the rate of ovarian cancer, as well as to confer protection against breast cancer and decrease the subsequent risk of ovarian surgery. However, ovarian cancer is an uncommon malignant disease. In contrast, the beneficial effects of conserving the ovaries are well known and include a reduction of the risks of cardiovascular disease, osteoporotic fracture, dementia, Parkinson's disease, and sexual dysfunction, as well as a decrease in the incidence of menopausal symptoms and mortality. Consequently, ovarian conservation until the age of 65 years is associated with higher survival rates.The present article analyzes the pros and cons of both approaches and concludes that the only indications for performing simultaneous oophorectomy at hysterectomy in benign processes would be the presence of BRCA1 and 2 mutations or severe endometriosis and, finally, patient choice.
    Clínica e Investigación en Ginecología y Obstetricia 05/2009; 36(3). DOI:10.1016/j.gine.2009.01.001
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