Bone mineral density and fractures after surgical menopause: systematic review and meta‐analysis

Abstract

Background Oophorectomy is recommended for women at increased risk for ovarian cancer. When performed at premenopausal age oophorectomy induces acute surgical menopause, with unwanted consequences. Objective To investigate bone mineral density (BMD) and fracture prevalence after surgical menopause. Search strategy A literature search of PubMed, EMBASE and Cochrane library was performed with no date restriction. Date of last search was March 1st, 2016. Selection criteria Primary studies reporting on BMD, T‐scores or fracture prevalence in women with surgical menopause and age‐matched control groups. Data collection and analysis Data were extracted on BMD (g/cm2), T‐scores and fracture prevalence in women with surgical menopause and control groups. Quality was assessed by an adaptation of the Downs and Black checklist. Random effects models were used to meta‐analyse results of studies reporting on BMD or fracture rates. Main results Seventeen studies were included, comprising 43 386 women with surgical menopause. Ten studies provided sufficient data for meta‐analysis. BMD after surgical menopause was significantly lower than in premenopausal age‐matched women [mean difference lumbar spine, −0.15 g/cm2 (95% CI, −0.19 to −0.11 g/cm2); femoral neck, −0.17 g/cm2 (95% CI, −0.23 to −0.11 g/cm2)] but not lower than in women with natural menopause [lumbar spine, −0.02 g/cm2 (95% CI, −0.04 to 0.00 g/cm2); femoral neck, 0.04 g/cm2 (95% CI, −0.09 to 0.16 g/cm2)]. Hip fracture rate was not higher after surgical menopause compared with natural menopause [hazard ratio: 0.85 (95% CI, 0.70 to 1.04)]. Author's conclusions No evident effect of surgical menopause was observed on BMD and fracture prevalence compared with natural menopause. However, available studies are prone to bias and need to be interpreted with caution. Tweetable abstract Bone health after menopause: no evidence for additional effect of surgical menopause on BMD and fractures.

Protective Effects of Melon Extracts on Bone Strength, Mineralization, and Metabolism in Rats with Ovariectomy-Induced Osteoporosis

“…Calcium is one of the most important minerals that prevents osteoporosis. In postmenopausal women, a decrease in estrogen secretion accelerates bone loss and increases the risk of osteoporosis [36], and a decrease in postmenopausal BMD was observed immediately after menopause and decreased exponentially with the lapse of time, due to the continuous decrease in bone mass after menopause [37]. However, BMD only explains a portion of the bone mechanical strength variance since age-related declines in bone strength are disproportionately steeper than decreases in BMD [38].…”

Comparison of osteoporotic fracture risk in surgical and natural menopausal patients

“…In one study, the mean BMD values were significantly lower in the surgical menopause group compared with the natural menopause group. [ 8 ] In a meta- analysis of Fakkert et al,[ 9 ] no difference was found between these two groups. In a study investigating the effect of age and menopause type on BMD, the values of patients with surgical menopause and natural menopause were shown to vary in different age groups.…”

Musculoskeletal Health in Premature Ovarian Insufficiency. Part Two: Bone

“…A recent meta-analysis, including studies using DXA, reported significantly lower BMD in women with surgical menopause than premenopausal age-matched controls; however, there was no evidence for an additional effect of surgical menopause on BMD and fractures compared with natural menopause. 97 Interestingly, an older study employing QCT detected an increased rate of bone loss following oophorectomy. 98…”