Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Brookline, Massachusetts.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.
J Am Geriatr Soc. 2018 Nov;66(11):2172-2177. doi: 10.1111/jgs.15505. Epub 2018 Sep 24.
To determine whether women with surgical menopause have a higher risk of frailty than naturally menopausal women.
Prospective cohort study with up to 18 years of follow-up.
Four U.S clinical centers.
Community-dwelling white women aged 65 and older (mean 71.2±5.2) enrolled in the Study of Osteoporotic Fractures (N=7,699).
Surgical menopause was based on participant self-report of having undergone bilateral oophorectomy before menopause. The outcome was incident frailty, classified as robust, prefrail, frail, or death at 4 follow-up interviews, conducted 6 to 18 years after baseline. Information on baseline serum total testosterone concentrations was available for 541 participants.
At baseline, 12.6% reported surgical menopause. Over the follow-up period, 22.0% died, and 10.1% were classified as frail, 39.7% as prefrail, and 28.3% as robust. Surgically menopausal women had significantly lower total serum testosterone levels (13.2 ± 7.8 ng/dL) than naturally menopausal women (21.7 ± 14.8 ng/dL) (p=0.000), although they were not at greater risk of frailty (adjusted odds ratio (aOR)=0.94, 95% confidence interval (CI)=0.72-1.22), prefrailty (aOR=0.96, 95% CI=0.80-1.10), or death (aOR=1.17, 95% CI=0.97-1.42) after adjusting for age, body mass index, and number of instrumental activity of daily living impairments. There was no evidence that oral estrogen use modified these associations.
In postmenopausal women, surgical menopause was not associated with greater risk for frailty than natural menopause, even in the absence of estrogen therapy. Future prospective studies are needed to investigate hormonal mechanisms involved in development of frailty in older postmenopausal women. J Am Geriatr Soc 66:2172-2177, 2018.
确定手术绝经的女性是否比自然绝经的女性更容易出现虚弱。
前瞻性队列研究，随访时间长达 18 年。
美国四个临床中心。
参加骨质疏松性骨折研究的社区居住的白种老年女性（平均年龄 71.2±5.2），年龄 65 岁及以上（N=7699）。
手术绝经基于参与者自述在绝经前接受了双侧卵巢切除术。结果是新发虚弱，在 4 次随访访谈中分类为健壮、虚弱前期、虚弱或死亡，随访时间为基线后 6 至 18 年。541 名参与者的基线血清总睾酮浓度信息可用。
基线时，12.6%的女性报告手术绝经。在随访期间，22.0%死亡，10.1%被归类为虚弱，39.7%为虚弱前期，28.3%为健壮。手术绝经女性的总血清睾酮水平明显低于自然绝经女性（13.2±7.8ng/dL 比 21.7±14.8ng/dL）（p=0.000），尽管她们患虚弱的风险没有增加（调整后的优势比（aOR）=0.94，95%置信区间（CI）=0.72-1.22），虚弱前期（aOR=0.96，95%CI=0.80-1.10）或死亡（aOR=1.17，95%CI=0.97-1.42），在调整年龄、体重指数和日常生活活动工具受损数量后。没有证据表明口服雌激素使用改变了这些关联。
在绝经后女性中，与自然绝经相比，手术绝经与虚弱风险增加无关，即使没有雌激素治疗。需要进一步的前瞻性研究来探讨与老年绝经后女性虚弱发展相关的激素机制。美国老年学会杂志 66：2172-2177，2018。
