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Am J Obstet Gynecol. 2019 Feb 12. pii: S0002-9378(19)30359-X. doi: 10.1016/j.ajog.2019.02.018. [Epub ahead of print]

Increased the risk of osteoporosis with hysterectomy: A longitudinal follow-up study using a national sample cohort.

Author information

1
Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea; Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea.
2
Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
3
Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea. Electronic address: ssugucap@naver.com.

Abstract

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.

KEYWORDS:

Cohort studies; Hysterectomy; Korea; Osteoporosis

PMID:
30768935
DOI:
10.1016/j.ajog.2019.02.018

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