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Bone mineral density and fractures after surgical menopause: a systematic review and meta-analysis.
2017-05-02

BJOG. 2017 Apr 24.
doi: 10.1111/1471-0528.14703. [Epub ahead of print]

Author
Fakkert IE1, Teixeira N1, Abma EM2, Slart RHJA3,4, Mourits MJE5, de Bock GH1.

Author information
1. University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700, RB, Groningen, the Netherlands.
2. University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Geriatric Medicine, PO Box 30.001, 9700, RB, Groningen, the Netherlands.
3. University of Groningen, University Medical Center Groningen, Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, PO Box 30.001, 9700, RB, Groningen, the Netherlands.
4. University of Twente, Department of Biomedical Photonic Imaging, Enschede, PO Box 217, 7500, AE, Enschede, The Netherlands.
5. University of Groningen, University Medical Center Groningen, Department of Gynaecology, PO Box 30.001, 9700, RB, Groningen, the Netherlands.

Abstract

BACKGROUND:
Oophorectomy is recommended to women at increased ovarian cancer risk. 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 on PubMed, Embase and Cochrane library through March 2016.

SELECTION CRITERIA:
Primary studies reporting on BMD, T-scores or fracture prevalence in women with surgical menopause and age-matched reference groups.

DATA COLLECTION AND ANALYSIS:
Data was extracted on BMD (grams/cm2 ), T-scores and fracture prevalence in women with surgical menopause and reference groups. Quality was assessed by an adaptation of Downs and Black's 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 compared to premenopausal age-matched women (mean difference lumbar spine: -0.15 g/cm2 , 95% CI: -0.19 - -0.11; femoral neck: -0.17 g/cm2 , 95% CI: -0.23 - -0.11) but not to women with natural menopause (lumbar spine: -0.02 g/cm2 , 95% CI: -0.04 - 0.00; femoral neck: 0.04 g/cm2 , 95% CI: -0.09 - 0.16). Hip fracture rate was not increased after surgical menopause compared to natural menopause (HR: 0.85, 95% CI: 0.70 - 1.04).

CONCLUSIONS:
No evident effect of surgical menopause was observed on BMD and fracture prevalence compared to natural menopause. However, available studies are prone to bias and need to be interpreted with caution. This article is protected by copyright. All rights reserved.

KEYWORDS:
bone mineral density; fractures; oophorectomy; surgical menopause

資料來源 : PubMed



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