Is Hysterectomy Associated with Increased Risk of Osteoporosis?

A study published in PLOS One found that women who have undergone a hysterectomy may be at an increased risk of developing osteoporosis or bone fracture.

Researchers conducted a retrospective, population-based cohort study from 2000 to 2013 using claims data from the Longitudinal Health Insurance Database 2000, a subset of the National Health Insurance Research Database. The study included 9,189 women aged ≥30 years who underwent hysterectomy between 2000 and 2012. Researchers also included a comparison group (n=33,942) that did not undergo hysterectomy and was randomly selected from a database and matched 1:4 based on age and index year.

Most of the cohort was predominantly insured individuals aged 40 to 49 years (61%) who lived in a high degree of urbanization, had an insurance premium between $15,000 and $30,000, and had a white-collar occupation.

Median follow-up was about seven years. The risk of subsequent osteoporosis or bone fracture was significantly higher in women who had undergone hysterectomy compared with the comparison group (incidence rate, 16.8 vs. 7.3 per 1,000 person-years; adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 2.09-2.44). In a subgroup analysis, oophorectomy (n=965) and estrogen therapy (n=1,046) increased the risk of osteoporosis or fracture in both groups.

The risk of vertebral fracture (aHR, 4.92; 95% CI, 3.78-6.40) was higher in the hysterectomy group than the comparison cohort. As follow-up time increased, the aHRs of vertebral fracture in women who had undergone hysterectomy were 4.33 at less than five years (95% CI, 2.99-6.28), 3.89 at five to nine years (95% CI, 2.60-5.82), and 5.42 at more than nine years (95% CI, 2.66-11.01).

“Based on the study results, women who undergo hysterectomy should be screened more readily or counseled regarding this risk of osteoporosis or fracture,” the researchers concluded.