Long-term Implications of Oophorectomy

TON - MARCH 2012 VOL 5, NO 2 — April 10, 2012

Oophorectomy in younger women leads to decreased bone mineral density (BMD) and a higher prevalence of arthritis, according to a study reported at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium. 

An estimated 300,000 women undergo oophorectomy each year in the United States for a variety of reasons. Women at high risk of breast cancer are recommended to have their ovaries removed at a younger age, and removal of the ovaries is often done together with hysterectomy, which is performed for several benign conditions, including fibroid tumors, explained lead author Anne Marie McCarthy, PhD, Johns Hopkins Bloomberg School of Public Health and Sidney Kimmel Comprehensive Cancer Center in Baltimore, Maryland. She and her colleagues wanted to explore the effect of oophorectomy at a younger age on bone health. 

“To our knowledge, this has not been reported before. Our study suggests that women who undergo oophorectomy at a younger age may have significant bone loss and may develop arthritis. These women should have their BMD closely monitored to prevent the development of osteoporosis. Longitudinal studies are needed to assess bone loss over time and the incidence of arthritis in women who undergo oophorectomy,” she told listeners.

The study was based on data from the third National Health and Nutrition Examination Survey (NHANES III) from 1988 to 1994. This study focused on women aged 40 years and older who answered detailed questionnaires that included questions about diagnosis of arthritis and BMD test results. Total hysterectomy and removal of ovaries was performed in 98% of the oophorectomy group. The BMD analysis included 3660 women and the arthritis analysis included 4039 women. Oophorectomy was performed in 560 women for a variety of reasons, excluding cancer surgery; the remaining women had intact ovaries. Low BMD was defined as BMD >2.0 standard deviations below the mean.

Among women who had never used hormone replacement therapy (HRT), those who had an oophorectomy before the age of 45 were more than twice as likely as those with intact ovaries to have low BMD. The odds of arthritis were similar with and without HRT.

Low BMD was reported in 28.8% of the oophorectomy group younger than 45 years, in 26% of those who had an oophorectomy after reaching 45 years, and in 23.3% of those with intact ovaries. Arthritis was diagnosed in 47.9% of younger women with oophorectomy, 41.5% of women older than 45 with oophorectomy, and 32% of those with intact ovaries. When HRT was excluded, the rates of low BMD in these 3 groups, respectively, were 50.7%, 33%, and 22.9%. The rates of arthritis in non-HRT users were 54%, 50.5%, and 28.7%, respectively. A multivariate analysis adjusted for age, race, smoking, alcohol, body mass index, parity, maternal history of osteoporosis, osteoporosis treatment, physical activity, calcium, and vitamin D found that age <45 at the time of oophorectomy was the strongest predictor for low BMD in the total study population. When HRT users were excluded, oophorectomy at a younger age remained a significant predictor of low BMD.

The odds of arthritis were similar with and without HRT in those who had oophorectomy, with younger women being twice as likely to get a diagnosis of arthritis as those with intact ovaries. McCarthy speculated that the explanation for an increased risk of arthritis found in this study might be related to deleterious effects on the joints and cartilage occurring with estrogen deprivation.

Future studies by these investigators will address pre- and post-oophorectomy effects on BMD and arthritis. These studies will involve collaboration with basic scientists, McCarthy said, noting that she is an epidemiologist.

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