Hysterectomy, oophorectomy, and bone health: a systematic review and meta-analysis
Abstract
OBJECTIVE: To review the association between hysterectomy, with and without oophorectomy, and fracture, osteoporosis, and bone mineral density (BMD) change.
METHODS: We undertook a systematic review and meta-analysis, searching PubMed, Embase, Cochrane Central, and CINAHL from inception to November 2024. Eligible studies included women aged ≥18 years and assessed the relationship between having a hysterectomy and/or oophorectomy and fracture, osteoporosis, or BMD.
RESULTS: Of 15 305 articles screened, 29 met the inclusion criteria, with 19 included in the meta-analyses. Bilateral oophorectomy compared to no oophorectomy was associated with a higher risk of fracture (pooled relative risk [RR] 1.17, 95% CI 1.03-1.33, 10 studies) and osteoporosis, although the latter was not statistically significant (RR 1.46, 95% CI 0.94-2.27, 4 studies). Hysterectomy with bilateral oophorectomy was not associated with a higher fracture risk compared to hysterectomy without oophorectomy (RR 0.99; 95% CI 0.83-1.18, 4 studies). However, hysterectomy without oophorectomy compared to no surgery was associated with a higher osteoporosis risk (RR 1.45; 95% CI 1.37-1.53, 2 studies). Findings showed moderate to high heterogeneity, and most studies did not account for variables such as age at surgery, menopausal hormone therapy use, and indications for surgery.
CONCLUSIONS: Our review supports evidence showing that bilateral oophorectomy is negatively associated with bone health and suggests that…
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