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Surgical menopause and nonvertebral fracture risk among older US women

Vesco, Kimberly K. MD, MPH, FACOG1,2; Marshall, Lynn M. ScD3; Nelson, Heidi D. MD, MPH4,5,6; Humphrey, Linda MD2,3,4; Rizzo, Joanne MPA1; Pedula, Kathryn L. MS1; Cauley, Jane A. DrPH7; Ensrud, Kristine E. MD8,9; Hochberg, Marc C. MD10; Antoniucci, Diana MD11; Hillier, Teresa A. MD, MS1; for the Study of Osteoporotic Fractures

doi: 10.1097/gme.0b013e318239caeb
Original Articles
Editorial

Objective: The aim of this study was to determine whether older postmenopausal women with a history of bilateral oophorectomy before natural menopause (surgical menopause) have a higher risk of nonvertebral postmenopausal fracture than women with natural menopause.

Methods: We used 21 years of prospectively collected incident fracture data from the ongoing Study of Osteoporotic Fractures, a cohort study of community-dwelling women without previous bilateral hip fracture who were 65 years or older at enrollment, to determine the risk of hip, wrist, and any nonvertebral fracture. χ2 and t tests were used to compare the two groups on important characteristics. Multivariable Cox proportional hazards regression models stratified by baseline oral estrogen use status were used to estimate the risk of fracture.

Results: Baseline characteristics differed significantly among the 6,616 women within the Study of Osteoporotic Fractures who underwent either surgical (1,157) or natural (5,459) menopause, including mean age at menopause (44.3 ± 7.4 vs 48.9 ± 4.9 y, P < 0.001) and current use of oral estrogen (30.2% vs 6.5%, P < 0.001). Fracture rates were not significantly increased for surgical versus natural menopause, even among women who had never used oral estrogen (hip fracture: hazard ratio [HR], 0.87; 95% CI, 0.63-1.21; wrist fracture: HR, 1.10; 95% CI, 0.78-1.57; any nonvertebral fracture: HR, 1.11; 95% CI, 0.93-1.32).

Conclusions: These data provide some reassurance that the long-term risk of nonvertebral fracture is not substantially increased for postmenopausal women who experienced premenopausal bilateral oophorectomy, compared with postmenopausal women with intact ovaries, even in the absence of postmenopausal estrogen therapy.

In this study, the long-term risk of nonvertebral fracture was not substantially increased for postmenopausal women who experienced premenopausal bilateral oophorectomy, compared with postmenopausal women with intact ovaries, even in the absence of postmenopausal estrogen therapy.

From the 1From the Center for Health Research, Portland, OR; 2Portland Veterans Affairs Medical Center Portland, OR; 3Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR; 4Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR; 5Department of Medicine, Oregon Health & Science University, Portland, OR; 6Women and Children’s Health Research Center, Providence Health & Services, Portland, OR; 7Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; 8Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN; and 9Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; 10Departments of Medicine and Epidemiology & Preventive Medicine, University of Maryland, Baltimore, MD; and 11Endocrine Research Unit, Department of Medicine, San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, CA.

Received August 4, 2011; revised and accepted September 26, 2011.

Funding/support: A significant portion of Dr. Vesco’s time on this project was supported by the Women’s Health Fellowship of the Portland Veterans Affairs Medical Center. The Study of Osteoporotic Fractures has received funding by the National Institute on Aging, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases provides support under the following grant numbers: 2 R01 AG027574-22A1, AR35582, AR35584, AR35583, R01 AG005407, R01 AG027576-22, and 2 R01 AG005394-22A1.

Financial disclosure/conflicts of interest: None reported.

Role of the sponsors: The funding agencies had no direct role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.

Address correspondence to: Kimberly K. Vesco, MD, MPH, FACOG, Science Programs Department, Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227. E-mail: Kimberly.k.vesco@kpchr.org

©2012The North American Menopause Society