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


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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    • "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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