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Published on: November 8, 2024
Influence of hysterectomy on long-term fracture risk
L Joseph Melton1, Sara J Achenbach, John B Gebhart
1Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. melton.j@mayo.edu
Objective:
To assess long-term fracture risk after hysterectomy, with or without oophorectomy.
Design:
Population-based, cohort study.
Setting:
Olmsted County, Minnesota.
Patient(S):
Women residing in Olmsted County (n = 9,258) who underwent hysterectomy in 1965-2002, compared to an equal number of age- and sex-matched community controls.
Intervention(S):
Observational study of the effect of hysterectomy for various indications on subsequent fractures.
Main Outcome Measure(S):
Fractures of any type, and at osteoporotic sites (e.g., hip, spine, or wrist) alone, as assessed by electronic review of inpatient and outpatient diagnoses in the community.
Result(S):
Compared with controls, there was a significant increase (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.13-1.29) in overall fracture risk among the women with a hysterectomy, but osteoporotic fracture risk was not elevated (HR, 1.09; 95% CI, 0.98-1.22). Most hysterectomy indications were associated with fractures generally, although these were not often statistically significant. Only operations for a uterine prolapse were associated with osteoporotic fractures (HR, 1.33; 95% CI, 1.01-1.74). Oophorectomy was not an independent predictor of fracture risk (HR, 1.0; 95% CI, 0.98-1.15).
Conclusion(S):
Hysterectomy does not appear to pose much long-term risk for fractures, but the association of fractures with surgery for uterine prolapse deserves further attention.