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: 6.83). 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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Available from: Byron Lawrence Riggs, May 24, 2015
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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 · 3.77 Impact Factor
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    • "Oophorectomy before age 45 is a well-established risk factor for osteoporosis (16). In addition, even the risk of osteoporotic fracture may be increased in women who undergo bilateral oophorectomy after natural menopause, in comparison to women with intact ovaries (17). Therefore, in this study surgical menopause might play a role in the bone loss in premenopausal patients after anticancer treatments. "
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    ABSTRACT: Although surgical menopause may increase the risks of osteoporosis, few studies have investigated the influence of chemotherapy and radiation therapy. The aim of this study is to evaluate the effects of treatments for gynecological malignancies on bone mineral density (BMD). This study enrolled 35 premenopausal women (15 ovarian cancers (OCs), 9 endometrial cancers (ECs), and 11 cervical cancers (CCs)) who underwent surgical treatment that included bilateral oophorectomy with or without adjuvant platinum-based chemotherapy in OC and EC patients, or concurrent chemo-radiation therapy (CCRT) in CC patients according to the established protocols at the Osaka Medical College Hospital between 2006 and 2008. The BMD of the lumbar spine (L1-L4) was measured by dual-energy X-ray absorptiometry, and urine cross-linked telopeptides of type I collagen (NTx) and bone alkaline phosphatase (BAP) were assessed for evaluation of bone resorption and bone formation respectively. These assessments were performed at baseline and 12 months after treatment. Although the serum BAP was significantly increased only in the CC group, a rapid increase in the bone resorption marker urinary NTx was observed in all groups. The BMD, 12 months after CCRT was significantly decreased in the CC group at 91.9±5.9% (P<0.05 in comparison to the baseline). This research suggests that anticancer therapies for premenopausal women with gynecological malignancies increase bone resorption and may reduce BMD, particularly in CC patients who have received CCRT. Therefore, gynecologic cancer survivors should be educated about these potential risks and complications.
    Endocrine Connections 03/2013; 2(1):11-7. DOI:10.1530/EC-12-0043
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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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