Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea.
JAMA Netw Open. 2023 Dec 1;6(12):e2347323. doi: 10.1001/jamanetworkopen.2023.47323.
Prior research about the association between hysterectomy and osteoporosis risk had limitations.
To assess osteoporosis and fracture risk among female patients who underwent hysterectomy due to benign conditions.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, female patients aged 40 to 59 years with benign hysterectomy between 2003 and 2011 were selected from Korean National Health Insurance Data and matched by 1:1 propensity score with female patients who had health checkups and indicated that they had not had a hysterectomy. A Cox proportional hazard model was used to analyze osteoporosis and fracture risk, with participants monitored until December 31, 2020. Data analysis was performed from July 16, 2022, to January 12, 2023.
Hysterectomy with or without adnexal surgical procedure.
The primary outcome was the risk of osteoporosis. Secondary outcomes included the risk of vertebral fracture, hip fracture, other fractures, and total fracture.
The study population included 25 910 patients; the median (IQR) age was 47 (44-50) years, and median (IQR) follow-up period was 10.9 (9.4-12.7) years. In the stratified-extended Cox proportional analysis, female patients who underwent hysterectomy without an adnexal surgical procedure were associated with a higher risk of osteoporosis within 7 years compared with female patients who did not undergo hysterectomy (hazard ratio [HR], 1.28 [95% CI, 1.19-1.37]); the analysis was divided into 7 years due to a violation of the Cox assumption, and the risk did not differ after 7 years (HR, 0.99 [95% CI, 0.93-1.06]). However, the hysterectomy group with an adnexal surgical procedure had an association with higher risk of osteoporosis compared with the nonhysterectomy group both within 7 years of study entry (HR, 1.56 [95% CI, 1.33-1.82]) and after 7 years (HR, 1.20 [95% CI, 1.04-1.40]). In the hysterectomy group without an adnexal surgical procedure, the risks of vertebral fracture, hip fracture, and total fracture were similar to those in the nonhysterectomy group. Similar trends were observed in the hysterectomy group with an adnexal surgical procedure.
Hysterectomy without an adnexal surgical procedure was associated with an increased osteoporosis risk within 7 years, but not afterwards, compared with the nonhysterectomy group. Hysterectomy was not associated with vertebral and hip fractures.
先前关于子宫切除术与骨质疏松风险之间关联的研究存在局限性。
评估因良性疾病而接受子宫切除术的女性患者的骨质疏松症和骨折风险。
设计、设置和参与者：在这项回顾性队列研究中，从 2003 年至 2011 年，选择了年龄在 40 至 59 岁之间、因良性疾病接受子宫切除术的女性患者，并通过 1:1 倾向评分与接受健康检查且表示未接受过子宫切除术的女性患者进行匹配。使用 Cox 比例风险模型分析骨质疏松症和骨折风险，参与者的监测时间截至 2020 年 12 月 31 日。数据分析于 2022 年 7 月 16 日至 2023 年 1 月 12 日进行。
伴或不伴附件手术的子宫切除术。
主要结局是骨质疏松症的风险。次要结局包括椎体骨折、髋部骨折、其他骨折和总骨折的风险。
研究人群包括 25910 名患者；中位（IQR）年龄为 47（44-50）岁，中位（IQR）随访时间为 10.9（9.4-12.7）年。在分层扩展 Cox 比例分析中，与未接受子宫切除术的女性患者相比，未行附件手术的子宫切除术患者在 7 年内发生骨质疏松症的风险更高（风险比[HR]，1.28[95%CI，1.19-1.37]）；由于违反 Cox 假设，分析分为 7 年，7 年后风险无差异（HR，0.99[95%CI，0.93-1.06]）。然而，伴有附件手术的子宫切除术组与无子宫切除术组相比，在研究入组后 7 年内（HR，1.56[95%CI，1.33-1.82]）和 7 年后（HR，1.20[95%CI，1.04-1.40]）均与更高的骨质疏松症风险相关。在未行附件手术的子宫切除术组中，椎体骨折、髋部骨折和总骨折的风险与非子宫切除术组相似。在伴有附件手术的子宫切除术组中也观察到类似的趋势。
与非子宫切除术组相比，无附件手术的子宫切除术在 7 年内与更高的骨质疏松症风险相关，但 7 年后无相关性。子宫切除术与椎体骨折和髋部骨折无关。
