Hysterectomy unrelated osteoporotic fractures

Hysterectomy that includes the removal of the ovaries does not pose much of a long-term risk for fractures due to osteoporosis, the results of a study in the journal Fertility and Sterility suggest.

Osteoporosis is a common problem in older women once they experience a drop in estrogen levels that accompanies menopause. Therefore, removing the uterus and the adjoining ovaries, which produce estrogen, might increase the risk of osteoporosis and associated fractures.

To investigate, Dr. L. Joseph Melton, and colleagues from the Mayo Clinic College of Medicine, Rochester, Minnesota, compared 9,258 women living in Olmstead County who underwent hysterectomy between 1965 and 2002 with an equal number of similar women who did not have the operation.

Of the 9,258 hysterectomies, 6,353 (69 percent) were performed as a single procedure and 2,905 (31 percent) were combined with another operation.

Hysterectomy alone or combined with ovary removal did not increase the risk of osteoporotic bone fractures. However, hysterectomy was tied to an increased risk of fractures in general. This may be because the reason for hysterectomy, such as uterine cancer, is tied to an elevated risk, but not the operation per se, the authors note.

Interestingly, the researchers found that uterine prolapse, a condition in which the uterus protrudes into the vagina, was tied to an increased risk of osteoporotic fracture.

"Our overall results indicate that osteoporotic fractures do not represent a substantial problem for most women undergoing hysterectomy, whether or not (ovary removal) is performed," the investigators conclude. They add that the association with uterine prolapse "deserves further attention."

SOURCE: Fertility and Sterility, July 2007.