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

Abstract

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 abstract: Bone health after menopause: no evidence for additional effect of surgical menopause on BMD and fractures.

Keywords: Bone mineral density; fractures; oophorectomy; surgical menopause.