Bone mineral density and fractures after surgical menopause: systematic review and meta‐analysis

Bone mineral density and fractures after surgical menopause: systematic review and meta‐analysis

Background Oophorectomy is recommended for women at increased risk for ovarian cancer. When performed at premenopausal age oophorectomy induces acute surgical menopause, with unwanted consequences. Objective To investigate bone mineral density (BMD) and fracture prevalence after surgical menopause....

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Bibliographic Details
Published in:BJOG : an international journal of obstetrics and gynaecology Vol. 124; no. 10; pp. 1525 - 1535
Main Authors: Fakkert, IE, Teixeira, N, Abma, EM, Slart, RHJA, Mourits, MJE, Bock, GH
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01-09-2017
Subjects:
Adult
Bone Density
Bone mineral density
Data processing
Evidence-based medicine
Female
Femur
Fractures
Fractures, Bone - epidemiology
Fractures, Bone - etiology
Hip
Humans
Literature reviews
Menopause
Menopause, Premature - physiology
Meta-analysis
Middle Aged
oophorectomy
Ovarian cancer
Ovariectomy
Ovariectomy - adverse effects
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Period
Spine (lumbar)
surgical menopause
Systematic review
Womens health
Bone mineral density
oophorectomy
surgical menopause
fractures
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Summary:Background Oophorectomy is recommended for women at increased risk for ovarian cancer. When performed at premenopausal age oophorectomy induces acute surgical menopause, with unwanted consequences. Objective To investigate bone mineral density (BMD) and fracture prevalence after surgical menopause. Search strategy A literature search of PubMed, EMBASE and Cochrane library was performed with no date restriction. Date of last search was March 1st, 2016. Selection criteria Primary studies reporting on BMD, T‐scores or fracture prevalence in women with surgical menopause and age‐matched control groups. Data collection and analysis Data were extracted on BMD (g/cm2), T‐scores and fracture prevalence in women with surgical menopause and control groups. Quality was assessed by an adaptation of the Downs and Black checklist. Random effects models were used to meta‐analyse results of studies reporting on BMD or fracture rates. Main results Seventeen studies were included, comprising 43 386 women with surgical menopause. Ten studies provided sufficient data for meta‐analysis. BMD after surgical menopause was significantly lower than in premenopausal age‐matched women [mean difference lumbar spine, −0.15 g/cm2 (95% CI, −0.19 to −0.11 g/cm2); femoral neck, −0.17 g/cm2 (95% CI, −0.23 to −0.11 g/cm2)] but not lower than in women with natural menopause [lumbar spine, −0.02 g/cm2 (95% CI, −0.04 to 0.00 g/cm2); femoral neck, 0.04 g/cm2 (95% CI, −0.09 to 0.16 g/cm2)]. Hip fracture rate was not higher after surgical menopause compared with natural menopause [hazard ratio: 0.85 (95% CI, 0.70 to 1.04)]. Author's conclusions No evident effect of surgical menopause was observed on BMD and fracture prevalence compared with natural menopause. However, available studies are prone to bias and need to be interpreted with caution. Tweetable Bone health after menopause: no evidence for additional effect of surgical menopause on BMD and fractures. Tweetable Bone health after menopause: no evidence for additional effect of surgical menopause on BMD and fractures.
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ISSN:1470-0328
1471-0528
DOI:10.1111/1471-0528.14703