Bone health after menopause: effect of surgical menopaus on bone mineral density and osteoporosis
Keywords:Osteoporosis, Osteopenia, Hysterectomy, Bone mineral density, DEXA
Background: Natural menopause or surgical menopause is associated with endocrinological changes and alteration in bone and mineral metabolism. Hence this study was conducted to assess the bone mineral density changes in women with surgical menopause.
Methods: This is a prospective observational study conducted in the department of obstetrics and gynaecology at Sri Ramachandra medical college, which is a tertiary care teaching hospital. 60 women with surgical menopause were included in the study. BMD was assessed by dual energy X-ray absorptiometry at the lumbar spine and hip joint. All the data was entered in Microsoft excel spread sheet and analysed by using SPSS software.
Results: Among 60 study subjects, 41 individuals had a normal BMD, 16 had osteopenia, and 3 were diagnosed with osteoporosis. Osteopenia and osteoporosis is significantly higher in patients who had undergone hysterectomy with removal of ovaries. Observations of osteopenia and osteoporosis were significantly higher with increasing number of years post hysterectomy.
Conclusions: Prevalence of osteoporosis is high in patients who undergo hysterectomy. Oophorectomy is associated with postoperative bone loss. Targeted management strategies should include routine BMD assessment and hormone therapy improves management of bone health in this population. Further more studies are needed in large populations to test alternative treatments for post oophorectomy osteoporosis.
Lane NE. Epidemiology, etiology and diagnosis of osteoporosis. Am J Obstet Gynecol. 2006;194:S3-11.
Mazziotti G, Bilezikian J, Canalis E, Cocchi D, Giustina A. New understanding and treatments for osteoporosis. Endocrine. 2012;41:58-69.
Pinheiro MM, Reis Neto ET, Machado FS, Omura F, Yang JH, Szejnfeld J, et al. Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women. Rev Saude Publica. 2010;44:479-85.
John N, Morgan BD. The loss of bone with age; osteoporosis and fractures. Clin Ortho. 1970;71:229-32.
Deepthi SK, Amar G, Naryan R, Naidu JN. Study of biochemical bone turnover markers in postmenopausal women leading to osteoporosis. Int J Appl Bio Pharmaceut Technol. 2012;3:301-05.
Yildiz A, Sahin I, Gol K, Taner Z, Ulutiirk A. Bone loss rate in the lumbar spine: a comparison between natural and surgically induced menopause. Int J Gynecol Obstet. 1996;55:151-9.
Kumari P, Rao R, Dhiman B. Comparison of serum mineral levels in perimenopausal women with surgical menopausal women: Analytical cross sectional study. Int J Clin Obstet Gynecol.2020;4(4):324-6.
Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996; 312(7041):1254-9.
Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368-81.
Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, et al. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int. 2012;23:94955.
Simoes R. Effects of simple hysterectomy on bone loss. J Sao Paulo Medical. 1995;113(6):1012-6.
Erekson E, Martin D, Ratner E. Oophorectomy: the debate between ovarian conservation and elective oophorectomy. Menopause. 2013;20(1):110-4.
Limpaphayom KK, Taechakraichana N, Jaisamrarn U, Bunyavejchevin S, Chaikittisilpa S, Poshyachinda M, et al. Prevalence of osteopenia and osteoporosis in Thai women. Menopause. 2001;8(1):65-9.
Haussler B, Gothe H, Göl D, Glaeske G, Pientka L, Felsenberg D. Epidemiology, treatment and costs of osteoporosis in Germany-the Bone EVA Study. Osteoporosis Int. 2007;18(1):77-84.
Gopinath VR, Johnson P, Kumar AP, Pratibha M, Subhashini AS, Menon G. Prevalence of osteoporosis and evaluation of its risk factors in surgical and natural postmenopausal women: a pilot study. Sri Ramachandra J Med. 2010;3(1):9-13.
Klauss SV. Bone loss in premenopausal women: results of a prospective observational study over 9 years. Climacteric. 2002;15(5):433-40.
Cheng S, Sievänen H, Heinonen A, Uusi-Rasi K, Carbone L, Tylavsky F, et al. Does hysterectomy with ovarian conservation affect bone metabolism and density?. J Bone Mineral Metabol. 2003;21(1): 12-6.
Kritz-Silverstein D, Mühlen DGV, Barrett-Connor E. Hysterectomy and oophorectomy are unrelated to bone loss in older women. Maturitas. 2004;47(1):61-9.
Shamim S, Lal M, Shamim R. Prevalence of osteoporosis in hysterectomised as compared to non-hysterectomized women in 7th decade of life. Int J Reprod Contracept Obstet Gynecol. 2015;7(5):1975.
Surangtip S, Sakondhavat C, Soontrapa S, Kaewrudee S, Somboonporn W. Prevalence of osteoporosis in postmenopausal women at Srinagarind Hospital, Khon Kaen University. Thai J Obstet Gynaecol. 2010:26-34.
Agarwal SC, Dumitriu M, Tomlinson GA, Grynpas MD. Medieval trabecular bone architecture: the influence of age, sex, and lifestyle. Am J Anthropol. 2004;124(1):33-44.