Hysterectomies are associated with an increased risk of osteoporosis and bone fracture: A population-based cohort study

Yeh, Ying-Ting; Li, Pei-Chen; Wu, Kun-Chi; Yang, Yu‐Cih; Chen, Weishan; Yip, Hei-Tung; Wang, Jen-Hung; Lin, Shinn‐Zong; Ding, Dah‐Ching

doi:10.1371/journal.pone.0243037

Cited by 13 publications

(24 citation statements)

References 32 publications

(38 reference statements)

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“…1 Apart from the immediate complications of surgery in general, the aftermath includes increased risk of cardiovascular diseases, early deaths, dementia, osteoporosis, vault prolapse, incontinence, sexual dysfunction, and the much less talked about the impact on psychological and emotional health. [2][3][4][5][6][7][8][9] More recently hysterectomy with or without oophorectomy is also being reported to be associated with an increased risk of diabetes mellitus 10 and hypertension. 11 The appropriateness of recommendations for hysterectomy thus has gained an interest in scrutiny and debate by media and activists alike.…”

Section: Introductionmentioning

confidence: 99%

An Audit of Hysterectomy in a Teaching Hospital in India- Story of a Decade

Pandey

Hebbar

Innukollu³

et al. 2023

Journal of the Chinese Medical Association

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Background: The appropriateness of hysterectomy has gained an interest in scrutiny and debate. Periodic audits of the prevailing clinical practices are imperative for insight, and to formulate recommendations and guidelines. We report the temporal trends of hysterectomies, over the last 10 years in a teaching hospital. Methods: Present study involved all patients who underwent hysterectomy at a teaching hospital, from January 1, 2012 to December 31, 2021. Patients were identified by medical record tracking using International Classification of Diseases-9 codes. Case records were reviewed for demography, indication for surgery, approach, complications, hospital stay, and histopathological correlation.Results: Over the years the absolute number of hysterectomies in our hospital has ranged from 414 to 597 (mean 476), barring the coronavirus 19 pandemic year. The proportion of hysterectomy among all gynaecological admissions has ranged from 6% to 9%, except in 2020 where this proportion dropped down to 4%. The indications, age distribution, surgical approach, and complications have remained almost same. Conclusion:We report a static trend in hysterectomy over the past 10 years. This audit provides an insight for the need of shifting the abdominal to vaginal route, in carefully chosen patients. This will be beneficial for the patients, and for the trainees, where they can learn under supervision. Availability and patient education about the nonsurgical management options for benign gynecological conditions, as well as awareness about sequelae of hysterectomy, will bring down the rate in countries such as India.

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Section: Introductionmentioning

confidence: 99%

An Audit of Hysterectomy in a Teaching Hospital in India- Story of a Decade

Pandey

Hebbar

Innukollu³

et al. 2023

Journal of the Chinese Medical Association

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“…Moorman et al 14 18 However, this study also noted that the association of hysterectomy without an adnexal surgical procedure with osteoporosis was only significant within 7 years of the procedure and did not affect the risk of vertebral and hip fractures in the hysterectomy group compared with the nonhysterectomy group.…”

Section: Hysterectomy and Ovarian Functionmentioning

confidence: 48%

Osteoporosis and Fracture Risk Following Benign Hysterectomy Among Female Patients in Korea

Seo,

Yuk

2023

JAMA Netw Open

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IMPORTANCEPrior research about the association between hysterectomy and osteoporosis risk had limitations.OBJECTIVETo assess osteoporosis and fracture risk among female patients who underwent hysterectomy due to benign conditions.DESIGN, SETTING, AND PARTICIPANTSIn this retrospective cohort study, female patients aged 40 to 59 years with benign hysterectomy between 2003 and 2011 were selected from Korean National Health Insurance Data and matched by 1:1 propensity score with female patients who had health checkups and indicated that they had not had a hysterectomy. A Cox proportional hazard model was used to analyze osteoporosis and fracture risk, with participants monitored until December 31, 2020. Data analysis was performed from July 16, 2022, to January 12, 2023.EXPOSURESHysterectomy with or without adnexal surgical procedure.MAIN OUTCOMES AND MEASURESThe primary outcome was the risk of osteoporosis. Secondary outcomes included the risk of vertebral fracture, hip fracture, other fractures, and total fracture.RESULTSThe study population included 25 910 patients; the median (IQR) age was 47 (44-50) years, and median (IQR) follow-up period was 10.9 (9.4-12.7) years. In the stratified-extended Cox proportional analysis, female patients who underwent hysterectomy without an adnexal surgical procedure were associated with a higher risk of osteoporosis within 7 years compared with female patients who did not undergo hysterectomy (hazard ratio [HR], 1.28 [95% CI, 1.19-1.37]); the analysis was divided into 7 years due to a violation of the Cox assumption, and the risk did not differ after 7 years (HR, 0.99 [95% CI, 0.93-1.06]). However, the hysterectomy group with an adnexal surgical procedure had an association with higher risk of osteoporosis compared with the nonhysterectomy group both within 7 years of study entry (HR, 1.56 [95% CI, 1.33-1.82]) and after 7 years (HR, 1.20 [95% CI, 1.04-1.40]). In the hysterectomy group without an adnexal surgical procedure, the risks of vertebral fracture, hip fracture, and total fracture were similar to those in the nonhysterectomy group. Similar trends were observed in the hysterectomy group with an adnexal surgical procedure.CONCLUSIONS AND RELEVANCEHysterectomy without an adnexal surgical procedure was associated with an increased osteoporosis risk within 7 years, but not afterwards, compared with the nonhysterectomy group. Hysterectomy was not associated with vertebral and hip fractures.

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“… 27 Taken together, there is limited evidence to suggest reverse causality is a major driver of our findings, particularly noting that our sample extends as young as 20 years. Hysterectomy is also associated with chronic conditions later in life, including increased risk of cardiovascular disease, 7 osteoporosis, 28 and certain types of cancer ( e.g. , thyroid), 29 many of which may be a source of disability.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey

Scime

Brown

Metcalfe

et al. 2021

Women's Health Reports

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Introduction: Our objective was to investigate differences in prevalence of hysterectomy by self-reported disability status among Canadian women. Materials and Methods: We analyzed cross-sectional data from the Canadian Community Health Survey 2012 on 30,170 women aged ≥20 years. Disability was defined as reports of sometimes or often (vs. never) experiencing functional limitations or reduction in daily activities at home, school, or work. Frequency of these limitations was used as a proxy for disability severity. The outcome was self-reported hysterectomy status. Modified Poisson regression was used to quantify the prevalence ratio (PR) and 95% confidence interval (CI) for hysterectomy according to any, functional, or activity-limiting disability, after adjustment for household income, employment, education, ethnicity, and marital status. Results were stratified by age at time of data collection, categorized as childbearing (20–44 years), perimenopausal (45–59 years), and postmenopausal (60 years and older). Results: Disability was significantly and consistently associated with higher prevalence of hysterectomy in women. The strength of association was inversely related to age category, and PRs for a given age category were similar across disability types and severity levels. PRs for the association between any disability and hysterectomy were 2.18 (95% CI 1.36–3.50) for childbearing-aged women, 1.48 (95% CI 1.21–1.80) for perimenopausal women, and 1.12 (95% CI 1.02–1.24) for postmenopausal women. Conclusions: Prevalence of hysterectomy is disproportionately higher among women with self-reported disabilities compared with women without disabilities, with these differences most pronounced in women of childbearing age.

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Hysterectomies are associated with an increased risk of osteoporosis and bone fracture: A population-based cohort study

Cited by 13 publications

References 32 publications

An Audit of Hysterectomy in a Teaching Hospital in India- Story of a Decade

An Audit of Hysterectomy in a Teaching Hospital in India- Story of a Decade

Osteoporosis and Fracture Risk Following Benign Hysterectomy Among Female Patients in Korea

Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey

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