Risk of Fracture After Bilateral Oophorectomy

Trine K Hueg; Martha Hickey; Astrid L Beck; Louise F Wilson; Cecilie S Uldbjerg; Lærke Priskorn; Julie Abildgaard; Youn-Hee Lim; Elvira V Bräuner

doi:10.1002/jbm4.10750

Risk of Fracture After Bilateral Oophorectomy

JBMR Plus. 2023 May 1;7(7):e10750. doi: 10.1002/jbm4.10750. eCollection 2023 Jul.

Authors

Trine K Hueg^{1

2}, Martha Hickey³, Astrid L Beck^{1

2}, Louise F Wilson⁴, Cecilie S Uldbjerg^{1

2}, Lærke Priskorn^{1

2}, Julie Abildgaard⁵, Youn-Hee Lim^{6

7}, Elvira V Bräuner^{1

2}

Affiliations

¹ Department of Growth and Reproduction Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark.
² International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark.
³ Department of Obstetrics and Gynaecology University of Melbourne Melbourne Australia.
⁴ NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health The University of Queensland Herston Australia.
⁵ Centre for Physical Activity Research Rigshospitalet, University of Copenhagen Copenhagen Denmark.
⁶ Section of Environmental Health, Department of Public Health University of Copenhagen Copenhagen Denmark.
⁷ Seoul National University Medical Research Center Seoul Republic of Korea.

Abstract

Fragility fractures, resulting from low-energy trauma, occur in approximately 1 in 10 Danish women aged 50 years or older. Bilateral oophorectomy (surgical removal of both ovaries) may increase the risk of fragility fractures due to loss of ovarian sex steroids, particularly estrogen. We investigated the association between bilateral oophorectomy and risk of fragility fracture and whether this was conditional on age at time of bilateral oophorectomy, hormone therapy (HT) use, hysterectomy, physical activity level, body mass index (BMI), or smoking. We performed a cohort study of 25,853 female nurses (≥45 years) participating in the Danish Nurse Cohort. Nurses were followed from age 50 years or entry into the cohort, whichever came last, until date of first fragility fracture, death, emigration, or end of follow-up on December 31, 2018, whichever came first. Cox regression models with age as the underlying time scale were used to estimate the association between time-varying bilateral oophorectomy (all ages, <51/≥51 years) and incident fragility fracture (any and site-specific [forearm, hip, spine, and other]). Exposure and outcome were ascertained from nationwide patient registries. During 491,626 person-years of follow-up, 6600 nurses (25.5%) with incident fragility fractures were identified, and 1938 (7.5%) nurses had a bilateral oophorectomy. The frequency of fragility fractures was 24.1% in nurses who were <51 years at time of bilateral oophorectomy and 18.1% in nurses who were ≥51 years. No statistically significant associations were observed between bilateral oophorectomy at any age and fragility fractures at any site. Neither HT use, hysterectomy, physical activity level, BMI, nor smoking altered the results. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Keywords: EPIDEMIOLOGY; FRACTURE RISK ASSESSMENT; GENERAL POPULATION STUDIES; HORMONE REPLACEMENT; MENOPAUSE.