Increased the risk of osteoporosis with hysterectomy: A longitudinal follow-up study using a national sample cohort.
Am J Obstet Gynecol. 2019 Feb 12;: Authors: Choi HG, Jung YJ, Lee SW
BACKGROUND: Premenopausal hysterectomy is associated with a decreased ovarian reserve, follicular atresia, and subsequently reduced long-term estrogen secretion. Therefore, women who undergo hysterectomy will experience greater gradual bone mineral loss than women with an intact uterus and have an increased risk of osteoporosis. OBJECTIVE: This study aimed to evaluate the association between hysterectomy without/with bilateral oophorectomy (BO) and the occurrence of osteoporosis using a national sample cohort from South Korea. STUDY DESIGN: Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients who had undergone hysterectomy (n = 9,082) and for a 1:4 matched control group (n = 36,328) and then analyzed the occurrence of osteoporosis. The patients were matched according to age, sex, income, region of residence, and past medical history. A Cox proportional hazards model was used to analyze the hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses were performed based on age and BO status. The age of the participants was defined as the age at the time of hysterectomy. RESULTS: The adjusted HR for osteoporosis was 1.45 (95% CI = 1.37-1.53, P < .001) in the hysterectomy group. The adjusted HRs for osteoporosis in the different age subgroups of this group were 1.84 (95% CI = 1.61-2.10) for ages 40-44 years, 1.52 (95% CI = 1.39-1.66) for ages 45-49 years, 1.44 (95% CI = 1.28-1.62) for ages 50-54 years, 1.61 (95% CI = 1.33-1.96, all P < .001) for ages 55-59 years and 1.08 (95% CI = 0.95-1.23, P = .223) for ages ≥ 60 years. The adjusted HRs for osteoporosis according to hysterectomy/oophorectomy status were 1.43 (95% CI = 1.34-1.51) in the hysterectomy without BO group and 1.57 (95% CI = 1.37-1.79) in the hysterectomy with BO group. CONCLUSION: The occurrence of osteoporosis was increased in patients who had undergone hysterectomy compared to that in matched control subjects regardless of BO status. PMID: 30768935 [PubMed - as supplied by publisher]