Randell Kaisa M, Honkanen Risto J, Tuppurainen Marjo T, Kröger Heikki, Jurvelin Jukka S, Saarikoski Seppo
Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland.
Maturitas. 2006 Feb 20;53(3):333-42. doi: 10.1016/j.maturitas.2005.06.002. Epub 2005 Jul 12.
Fracture risk and bone mineral density (BMD) among peri- and early postmenopausal women with leiomyomas requiring hysterectomy was evaluated.
We counted fractures among women with or without leiomyomas using data from the Kuopio Osteoporosis Study. The study population consisted of 6086 women aged 47-56 years with never-use of hormone replacement therapy (HRT) responding to the baseline and 5-year follow-up inquiries. Part of the sample (n=1271) underwent bone densitometry.
Hysterectomy was carried out in 927 women, and 59% reported that this was attributable to leiomyomas. The hazard ratio (HR) was 0.68 (95% CI 0.49-0.94) for any and 0.73 (95% CI 0.43-1.26) for distal forearm fracture among women with leiomyomas compared to those without any. Among women postmenopausal at baseline, the corresponding HRs were 0.62 (95% CI 0.44-0.87) and 0.54 (95% CI 0.31-0.96); after adjusting for age, time since menopause weight, height and previous fracture 0.69 (95% CI 0.49-0.97) and 0.63 (95% CI 0.35-1.11). The baseline BMDs were 1.15 g/cm2 among hysterectomized leiomyoma and 1.12 g/cm2 (ns) among non-hysterectomized women at lumbar (L2-L4), and 0.94 and 0.93 g/cm2 (ns) at femoral sites. The follow-up lumbar BMDs were 1.13 and 1.09 g/cm2 (p<0.001) and the corresponding femoral values were 0.90 and 0.89 g/cm2 (ns), respectively. Among postmenopausal women, the corresponding baseline lumbar BMDs were 1.15 and 1.08 g/cm2 (p<0.001), femoral 0.93 and 0.90 g/cm2 (p=0.003); the follow-up lumbar BMDs 1.13 g/cm2 versus 1.07 g/cm2 (p<0.001); femoral BMDs 0.89 versus 0.87 (ns).
Peri- and early postmenopausal women with a history of leiomyomas seem to have better BMD and less fractures compared with those without leiomyomas. This may be mediated through higher estrogen levels leading to higher BMD and the growth of leiomyomas.
评估需要子宫切除的围绝经期和绝经后早期患有平滑肌瘤的女性的骨折风险和骨密度（BMD）。
我们利用库奥皮奥骨质疏松症研究的数据，统计了有或没有平滑肌瘤的女性的骨折情况。研究人群包括6086名年龄在47 - 56岁、从未使用过激素替代疗法（HRT）且对基线和5年随访询问有回应的女性。部分样本（n = 1271）进行了骨密度测量。
927名女性接受了子宫切除术，59%的人表示这是由平滑肌瘤所致。与没有平滑肌瘤的女性相比，患有平滑肌瘤的女性发生任何骨折的风险比（HR）为0.68（95%可信区间0.49 - 0.94），前臂远端骨折的HR为0.73（95%可信区间0.43 - 1.26）。在基线时绝经的女性中，相应的HR分别为0.62（95%可信区间0.44 - 0.87）和0.54（95%可信区间0.31 - 0.96）；在调整年龄、绝经后时间、体重、身高和既往骨折情况后，分别为0.69（95%可信区间0.49 - 0.97）和0.63（95%可信区间0.35 - 1.11）。子宫切除的平滑肌瘤患者腰椎（L2 - L4）的基线骨密度为1.15 g/cm²，未进行子宫切除的女性为1.12 g/cm²（无显著差异），股骨部位分别为0.94和0.93 g/cm²（无显著差异）。随访时腰椎骨密度分别为1.13和1.09 g/cm²（p<0.001），相应的股骨骨密度值分别为0.90和0.89 g/cm²（无显著差异）。在绝经后女性中，相应的基线腰椎骨密度分别为1.15和1.08 g/cm²（p<0.001），股骨为0.93和0.90 g/cm²（p = 0.003）；随访时腰椎骨密度为1.13 g/cm²对1.07 g/cm²（p<0.001）；股骨骨密度为0.89对0.87（无显著差异）。
与没有平滑肌瘤病史的围绝经期和绝经后早期女性相比，有平滑肌瘤病史的女性似乎骨密度更好，骨折更少。这可能是通过较高的雌激素水平导致更高的骨密度和平滑肌瘤生长来介导的。
