Influence of hysterectomy on long-term fracture risk

Asia-Oceania journal of obstetrics and gynaecology / AOFOG, 1992

The bone changes after gynecological surgery during the early phase of recovery were examined. The subjects were randomly selected from women who had undergone bilateral oopho-hysterectomies (OOX, n = 98, 46.0 +/- 5.0 year-old) or hysterectomies (HX, n = 75, 43.6 +/- 4.6 year-old) within 4 years prior to entering the study. The ovarian functions in the HX group were presumed to be intact following the hysterectomies, judging from the cytological evaluation of the vaginal pap smears. The bone morphological changes in both groups were examined to measure the cortical thickness of the metacarpal bone (MCI) on hands X-ray film using microdensitometry, and the posterior/anterior height ratios (P/A ratio) of the entire vertebral bodies, on vertebral X-ray films using a digitizer. The changes in bone mineral densities in both groups were measured by dual energy X-ray absorptiometry at lumbar vertebrae (L2-4 BMD) and by microdensitometry at the metacarpal cortical bone; the bone densities o...

Bone, 2008

Objective: The purpose of the study was to assess the cost effectiveness of hormone therapy (HT) for postmenopausal women without menopausal symptoms at an increased risk of fracture in Sweden, the UK and the US. Methods: Using a state-transition model, the cost effectiveness of 50 year old women was assessed based on a societal perspective and the medical evidence found in the Women Health Initiative (WHI) trials. The model had a lifetime horizon divided into cycle lengths of 1 year and comprised the following disease states: hip fracture, vertebral fracture, wrist fracture, breast cancer, colorectal cancer, coronary heart disease, stroke and venous thromboembolic events. An intervention was modelled by its impact on the disease risks during and after the cessation of treatment. The model required data on clinical effects, risks, mortality rates, quality of life weights and costs valid for Sweden, the UK and the US. The main outcome of the model was cost per QALY gained of HT compared to no treatment. Results: The results indicated that HT compared to no treatment was cost-effective for most sub-groups of hysterectomised women, whereas for women with an intact uterus without a previous fracture, HT was commonly dominated by no treatment. Fracture risks were the single most important determinant of the cost effectiveness results. Conclusions: HT is cost-effective in women with a hysterectomy irrespective of prior fracture status. In women with an intact uterus, opposed HT was cost-effective in those with a prior vertebral fracture, but cost-ineffective in women without a prior vertebral fracture. Even though HT is found cost-effective for a selection of osteoporotic women, it is unlikely to be considered for first-line therapy for osteoporosis because bisphosphonates have shown a similar reduction in fracture risks but without an increased risk of adverse events.

Therapy, 2006

In the treatment of menorrhagia, levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena ®) is compared with hysterectomy in terms of bone mineral density (BMD). In the lumbar spine, BMD decreased among hysterectomized women, but not among LNG-IUS users. Background: Osteoporosis is an increasing health problem. Osteoporotic fractures cause excess mortality, morbidity and heavy costs. Hysterectomy and LNG-IUS are the most effective treatment modalities for menorrhagia. However, the effect of these treatment modalities on BMD has not been compared. Design: Randomized controlled trial. Participants: 107 healthy women, aged 35-49, referred for menorrhagia. Interventions: Of the women, 54 were randomized to hysterectomy and 53 to the LNG-IUS group. Outcome measures: Bone mineral density measured by dual X-ray absoptiometry from the lumbar spine and the femoral neck at baseline and 5 years after randomization. Results: The two groups did not differ in terms of age, parity, body mass index, serum follicle-stimulating hormone, smoking, alcohol use, physical activity or daily calcium intake. There was no statistical significant difference in BMD between the treatment arms. However, lumbar spine BMD decreased significantly in the hysterectomy group but not in the LNG-IUS group. The change in BMD was not explained by factors included in the linear regression model. The BMD change in the femoral neck was similar in both arms. Conclusions: Hysterectomy may accelerate age-related loss in BMD, but studies with longer follow-up are needed.

American Journal of Epidemiology, 2001

The authors examined prospectively between 1986 and 1997 the relation of irregular menstrual cycles and irregular menstrual bleeding duration earlier in life with risk of hip fracture in 33,434 postmenopausal Iowa women. Over the 318,522 person-years of follow-up, 523 hip fractures were reported. Adjusted for age, smoking, body mass index, waist/hip ratio, and estrogen use, the relative risk of hip fracture in women who reported always having irregular menstrual cycles, compared with women who never had irregular cycles, was 1.36 (95% confidence interval (CI): 1.03, 1.78). Women who reported having irregular menstrual bleeding duration had a 1.40-fold (95% CI: 1.10, 1.78) increased risk of hip fracture compared with women with regular bleeding duration. In addition, women who reported having both irregular menstrual cycles and irregular menstrual bleeding had a 1.82-fold (95% CI: 1.55, 2.15) higher risk of hip fracture than did women who reported neither irregularity. Women who reported only one menstrual disturbance did not have a risk of hip fracture that was significantly different from women who reported no menstrual disturbances. The authors conclude that women with menstrual irregularities are at increased risk of hip fracture, probably because they are estrogen or progesterone deficient.

Osteoporosis International, 2005

Osteoporosis is a major public problem. More than 35 million Americans are at risk of developing osteoporosis. Nearly half of all women will have an osteoporotic fracture in their lifetime. Tubal ligation (tubal sterilization) is used more than any other single method of contraception in the USA and worldwide. In 1995, 34.6% (approximately 7 million) of ever-married US women between ages 35-44 years had undergone tubal ligation. Tubal sterilization may disturb ovarian function and be associated with more menstrual and menopausal symptoms and, thus, may be a risk factor for osteoporosis. The objective of this paper is to examine the possible association between tubal sterilization and osteoporotic fractures. Data are from a questionnaire mailed to a previously identified cohort of college/university alumnae who had graduated between 1926 and 1981. This study was performed during 1996 and 1997, 15 years after the initial study. The subjects were 3,940 women participants in the follow-up study. Their mean age was 53.7 years at time of reporting, ranging from 37 to over 80 years. Excluding deaths and non-deliverables the response rate was 85%. Of the 3,940 subjects, 491 (12.5%), and, of the ever-pregnant women, 15.5%, had undergone tubal sterilization (TS); 899 (22.8%) reported at least one fracture after age 20, and 70 (1.8%) at least one vertebral fracture after age 20, which had been confirmed by X-ray. TS was strongly associated with self-reports of vertebral fractures that had been confirmed by X-ray. The multivariable adjusted odds ratios and 95% confidence intervals for women 50 years and over and for women 55 years and over were, respectively, 2.7 (1.4, 5.0) and 3.3 (1.5, 7.0). Having had any fracture was not significantly associated with TS: odds ratio (OR) =1.1 for women 50 years and older and OR=1.3 for those 55 years and older. This epidemiological study in a cohort of highly educated, mostly Caucasian women shows an association between past tubal sterilization and self-reported X-ray-confirmed vertebral fractures. These results need to be confirmed in other cohorts-the pathophysiology of this association is worthy of further study.

JAMA, 2003

The most frequently performed major surgical procedure in the United States over the 20-year period 1965-84 was hysterectomy. It was done on 12.5 million women in the United States during this time; and by 1985, about 18.5 million women age 15 years and over in the United States had undergone the procedure. Within the United States, there are regional variations in hysterectomy rates. Women in the South were more likely than women in other regions to have had a hysterectomy, and hysterectomy was more likely to be performed on these women at an earlier age. The average length of stay for all hospital inpatients has decreased from 1965 through 1984; but for women who had a hysterectomy, the reduction in average length of stay has been dramatic-ffom 12.2 days in 1965 to 7.2 in 1984. Women were most likely to have had a hysterectomy during their 30’s and 40’s; with the median at 40.9 years. By 1985, 37.4 percent of women 55-59 years of age had had their uterus removed. Fibroids, prolapse, and endometriosis were the most common reasons for these women to have had a hysterectomy, accounting for about 62 percent of all hysterectomies fi-om 1970 through 1984. Cancer, the greatest life threatening condition leading to hysterectomy, accounted for an additional 10.7 percent. Even though the most common diagnosis for hysterectomy was fibriods, the rate of hysterectomy for endometriosis showed the largest overall increase. From 1965 through 1984, the number and rate of hysterectomies for endometriosis have increased. Prolapse was the only condition for hysterectomy that declined in frequency. Fibroids, endometriosis, and prolapse accounted for most hysterectomies for women under 65 years of age, 63 percent, but cancer and prolapse accounted for a majority in older women, about 74 percent. Most recent estimates from 1982 through 1984 show an increase in the rate of hysterectomies for cancer in women 65 years of age and over. As this report was being completed, data from the 1985 NHDS became available The estimated number of hysterectomies in 1985 was 670,000 (NCHS, 1986).

Journal of Minimally Invasive Gynecology, 2006

STUDY OBJECTIVE: To audit morbidity and mortality rates of laparoscopic, abdominal, and vaginal hysterectomy. DESIGN: Retrospective review of monthly morbidity and mortality rates (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: One thousand seven hundred ninety-two women who underwent hysterectomy for benign, nonobstetric indications at the Sir Mortimer B. Davis-Jewish General Hospital. INTERVENTIONS: Laparoscopic supracervical (LASH), vaginal (VH), and abdominal (AH) hysterectomies.

Joint Bone Spine, 2008

The aim is to describe the characteristics of osteoporotic pelvic fractures and their outcome. We recorded clinical and biological characteristics of 60 osteoporotic pelvic fractures hospitalized in our Department of Rheumatology and assessed their outcome in 51 cases, using a questionnaire administrated by phone call. In our population, pelvic fractures mainly affected elderly women (81.6% of women, mean age 79 years), presenting, in more than 50% of the cases, a past medical history of osteoporosis, previous fracture and cardiovascular disease. The fractures were triggered by a fall in 89% of the cases and mainly located at the pubic rami (65%). There was a high rate of vitamin D deficiency (80.6%) associated with a secondary hyperparathyroidism (51.6%). Before the pelvic fracture, all patients lived at their personal home and 84.1% were autonomous. During hospitalization, 52.5% of the patients experienced an adverse event, mostly related to urinary tract infection and bedsore. At time to discharge, only 31% directly returned to their own home. At the final assessment (mean delay from the fracture: 29 months), 11 patients were dead (mean delay: 190 days). Among living patients, 74.5% lived at home, 60% required assistance for at least one daily life activity and 18.6% experienced a new fracture. Only 63.2% were still treated for osteoporosis. Osteoporotic pelvic fractures requiring initial hospitalization share most characteristics of hip fracture: elderly people, women predominance, vitamin D insufficiency, fall triggering the fracture, and also the severity assessed by a high morbidity and mortality and loss of autonomy.

2016

9 Content 11 Abbreviations 13 Introduction 15 Background 17 Osteoporosis and fractures 17 Bone metabolism 17 Definition of osteoporosis 17 Other bone measurements 18 Primary and secondary osteoporosis 19 Risk factors for osteoporosis and fracture 20 Fracture risk assessment 21 The WHO fracture risk assessment tool FRAX® 23 Treatment of osteoporosis 24 Hormones and bone 25 Sex steroid synthesis 25 Oestrogen and bone 26 Androgens and bone 26 Sex steroid hormones and fracture risk 27 Cadmium 27 Cadmium background 27 Cadmium and bone 28 Aim 31 Overall aim 31 Study specific aims 31 Subjects and Methods 33 Subjects 33 Methods 35 Baseline data 35