Influence of hysterectomy on long-term fracture risk

Melton, L. Joseph; Achenbach, Sara J.; Gebhart, John B.; Babalola, Ebenezer O.; Atkinson, Elizabeth J.; Bharucha, Adil E.

doi:10.1016/j.fertnstert.2006.11.080

Cited by 22 publications

(12 citation statements)

References 39 publications

(34 reference statements)

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“…Our current and prior observations have been corroborated by Melton et al (27) who, in a retrospective cohort study of 9, 258 women followed for a median of 13.6 years following hysterectomy, described an association between prior surgery for uterine prolapse and fracture risk.…”

Section: Discussionsupporting

confidence: 87%

Increased incident hip fractures in postmenopausal women with moderate to severe pelvic organ prolapse

et al. 2011

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Objective To examine the association between fracture and pelvic organ prolapse (POP) in postmenopausal women enrolled in the Women’s Health Initiative Estrogen plus Progestin (WHI-EP) trial. Methods POP was assessed as cystocele, rectocele or uterine prolapse, and was graded as “absent-to- mild” or “moderate-to-severe”. Cox proportional hazard analyses (adjusting for age, BMI, race, asthma, emphysema, thyroid disease, family history of fracture, regular menses, age at menopause, nulliparity, history of hormone therapy [HT], history of falls, SES, calcium and vitamin D supplementation and physical activity) explored relationships between moderate-to-severe POP and incident bone fractures. Results Moderate-to-severe grade POP was identified in almost 8% of women (n=1,192). Over a follow up duration of 7.41 ± 2.18 years (mean ± SD), 2,156 incident fractures were observed; the most common fracture site was lower arm (n=615, 28.51%) followed by hip (n=205, 9.51%). Adjusted analyses confirmed moderate-to-severe POP (of any type) as an independent risk factor for incident hip fractures (HR 1.83, 95% CI 1.16–2.89, p=0.010). On analyses stratified by assigned treatment (HT versus placebo) moderate-to-severe rectocele emerged as an independent predictor of incident spine (HR 2.61, 95% CI 1.04–6.56, p=0.042) and lower arm fractures (HR 1.87, 95% CI 1.06–3.29, p=0.030) in the placebo group. Conclusion We identify moderate-to-severe POP (any type) in postmenopausal women as a risk factor for hip fracture; moderate-to-severe rectocele holds additional risk for spine and lower arm fractures in women not on HT.

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Section: Discussionsupporting

confidence: 87%

Increased incident hip fractures in postmenopausal women with moderate to severe pelvic organ prolapse

et al. 2011

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“…From the perspective of this review, the authors conjectured that hereditary connective tissue disorders might explain the observed relationships between pelvic floor dysfunction and osteoporosis; this is the first suggestion that connective tissue deficiency may indeed be a common pathophysiological mechanism that could explain the observed relationships between pelvic and skeletal compromise. Of interest is a single case report from the veterinary literature that identifies coexistent rectal prolapse and pelvic fracture in a free-ranging African black rhinocerous [37]; this observation builds upon the earlier reported suggestions of generalized connective tissue disturbance in the context of rectal prolapse put forth by Marshman et al . [35].…”

mentioning

confidence: 77%

Pelvic Organ Prolapse and Relationship with Skeletal Integrity

Pal

2009

Womens Health (Lond Engl)

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Health burden related to osteoporotic fractures in an aging female population far exceeds that imposed by other chronic disorders such as cardiovascular disease and breast cancer. Bone mineral density assessment and clinical risk factors provide independent insights into fracture risk in individuals. A finite list of clinical risk factors are identified as prognostic of fracture risk, namely among aging women, including low body mass, compromised reproductive physiology (e.g., prolonged periods of amenorrhea and early menopause), parental and personal histories of fracture, and alcohol and tobacco use. Pelvic organ prolapse is a common gynecologic entity and a contributor to age-related morbidities. The purpose of this review is to communicate data identifying pelvic organ prolapse as another clinical risk factor for fracture risk in postmenopausal women and to increase the caregiver's vigilance in anticipating and instituting preventive care strategies to a population (i.e., postmenopausal women with clinically appreciable pelvic organ prolapse) that may be at an enhanced lifetime risk for skeletal fractures.

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“…While hysterectomy leads to lower health care utilization over 5 years compared to women who undergo uterine-sparing procedures, there may be long-term adverse consequences of hysterectomy including fracture risk, pelvic organ prolapse, cardiovascular disease risk and risk of dementia, which may often take 20 to 30 years to manifest. 29–32 …”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Uterine Leiomyoma Procedures Using a Large Insurance Claims Database

Borah

Yao

Laughlin-Tommaso

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To compare risk of re-intervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent following procedures: hysterectomy, myomectomy, uterine artery embolization (UAE), and magnetic resonance–guided, focused ultrasound surgery. Methods This was a retrospective analysis of administrative claims from a large U.S. commercial insurance database. Women aged 18–54 years undergoing any of the above leiomyoma procedures between 2000 and 2013 were included. We assessed following outcome measures: risk of re-intervention between uterine-sparing procedures, risk of other surgical procedures or complications of the index procedure, 5-year health care utilization; pregnancy rates, and reproductive outcomes. Propensity score matching along with Cox proportional hazard models were used to adjust for differences in baseline characteristics between study cohorts. Results Among the 135,522 study-eligible women with mean follow-up of 3.4 years, hysterectomy was the most common first-line procedural therapy (111,324; 82.2%) followed by myomectomy (19,965; 14.7%), UAE (4,186; 3.1%) and magnetic resonance–guided focused ultrasound surgery (47; 0.0003%). Small but statistically significant differences were noted for UAE and myomectomy in re-intervention rate (17.1% versus 15.0%, p=0.02), subsequent hysterectomy rates (13.2% versus 11.1%, p<0.01) and subsequent complications from index procedures (18.1% versus 24.6%, p<0.001). During follow-up, women undergoing myomectomy had lower leiomyoma-related health care utilization, but had higher all-cause outpatient services. Pregnancy rates were 7.5% and 2.2% among myomectomy and UAE cohorts, respectively (p<0.001), with both cohorts having similar rate of adverse reproductive outcome (69.4%). Conclusions While the overwhelming majority of women having leiomyoma with bulk symptoms underwent hysterectomy as their first treatment procedure, among those undergoing uterine-sparing index procedures, approximately one seventh had a re-intervention, and one tenth ended up undergoing hysterectomy during follow-up. Compared with women undergoing myomectomy, women undergoing UAE had a higher risk of re-intervention, lower risk of subsequent complications, but similar rate of adverse reproductive outcomes.

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Influence of hysterectomy on long-term fracture risk

Cited by 22 publications

References 39 publications

Increased incident hip fractures in postmenopausal women with moderate to severe pelvic organ prolapse

Increased incident hip fractures in postmenopausal women with moderate to severe pelvic organ prolapse

Pelvic Organ Prolapse and Relationship with Skeletal Integrity

Comparative Effectiveness of Uterine Leiomyoma Procedures Using a Large Insurance Claims Database

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