Osteoporosis after Oophorectomy for Non-malignant Disease in Premenopausal Women

Aitken, J. M.; Hart, D.M.; Anderson, Jamie; Lindsay, Robert; Smith, D. A.; Speirs, C. F.

doi:10.1136/bmj.2.5862.325

Cited by 130 publications

(22 citation statements)

References 10 publications

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“…The role of estrogen deficiency in the pathogenesis of osteoporosis is well established [26,27] and estrogen replacement therapy after the menopause has been shown to prevent bone loss and reduce fracture risk at the wrist, spine and hip [28][29][30][31]. Most of the studies included younger postmenopausal women.…”

Section: Discussionmentioning

confidence: 97%

Ultrasound Measurements of Proximal Phalanges in Polish Early Postmenopausal Women

Pluskiewicz

Drozdzowska²

1998

Osteoporosis International

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The aim of this cross-sectional study was to evaluate skeletal status in Polish early postmenopausal women using ultrasound measurement at the proximal phalanges of the hand. We assessed the ability of the method to discriminate between healthy and osteoporotic individuals, the influence of age and menopause on ultrasound values, the impact of hormone replacement therapy and the relationships between ultrasound measurement and type of fracture. Five hundred and three early postmenopausal women were divided into three groups: (1) healthy (n = 398, mean age 53.4 years), (2) fractured (n = 43, mean age 53.9 years), (3) treated with estrogens (n = 62, mean age 53.5 years). Groups were matched for age and years since menopause (YSM). Group 2 was subdivided into those with and without wrist fracture. No drugs except estrogens were used by the subjects studied and no diseases known to affect bone metabolism were observed. Bone status was assessed by a DBM Sonic 1200 (Igea, Italy), a device that measures amplitude-dependent speed of sound (AD-SoS) at the proximal phalanges II-V of the hand. AD-SoS had the highest value in estrogen-treated women (1996.5 +/- 66.5 m/s), the lowest in fractured persons (1883.6 +/- 77.1 m/s) and a medium value in healthy women (1949.2 +/- 78.0 m/s). All values were significantly different from each other (p < 0.0001). AD-SoS values for the subgroups of group 2 were 1873.0 +/- 80.6 m/s for those with wrist fracture and 1914.0 +/- 73.0 m/s for those without; they were not statistically different. The hypothesis that AD-SoS at the proximal phalanges might be more sensitive to wrist fracture was not confirmed by Fisher's exact test for frequencies. Linear regression showed age-related changes, with r values -0.4 (p < 0.00001), -0.47 (p < 0.005), -0.37 (p < 0.005), and YSM-related changes, with r values of -0.44 (p < 0.00001), -0.32 (p < 0.005), and -0.18 (NS) in groups 1, 2 and 3, respectively. It is concluded that: (1) ultrasound measurements of the proximal phalanges were able to discriminate between healthy and osteoporotic individuals; (2) the method is useful in detecting age and postmenopause-related changes within the skeleton; and (3) hormone replacement therapy significantly reduced the impact of the menopause on bone loss as detected by ultrasound.

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Section: Discussionmentioning

confidence: 97%

Ultrasound Measurements of Proximal Phalanges in Polish Early Postmenopausal Women

Pluskiewicz

Drozdzowska²

1998

Osteoporosis International

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“…The prevalent concept that estrogen therapy prevents bone loss evolved during an era in which cortical bone was the only bone tissue accessible for study 23,24 . Most previous estrogen treatment studies following OVX are not comparable because they did not measure spinal cancellous bone by QCT 23,25–28 .…”

Section: Discussionmentioning

confidence: 99%

Premenopausal Ovariectomy-Related Bone Loss: A Randomized, Double-Blind, One-Year Trial of Conjugated Estrogen or Medroxyprogesterone Acetate

Prior

Vigna

Wark

et al. 1997

Journal of Bone and Mineral Research

108

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The purpose of this study was to contrast the effects of conventional estrogen treatment with medroxyprogesterone on cancellous and cortical bone change in the first year following premenopausal ovariectomy. This 1-year double-blind randomized therapy trial was stratified by osteoporosis family history and performed in an academic medical center and community hospitals. Premenopausal women 45 ؎ 5 years old, postovariectomy for benign diseases were provided 600 mg/day of calcium and randomized to daily therapy with conjugated equine estrogen (CEE, 0.6 mg) or medroxyprogesterone (MPA, 10 mg). The primary outcome variable was spinal quantitative computed tomography (QCT) bone density change over 1 year with additional outcomes of dual-energy X-ray absorptiometry (DXA) of proximal femur (FN), whole body (WB), and spine segment (WBS) and N-telopeptide, bone-specific alkaline phosphatase, and other bone marker, hormonal, and weight changes. Results in the 33 women completing the study, whose initial bone densities were normal (QCT 133 mg/cm 3 , femoral neck 0.94 g/cm 2 , whole body DXA 1.13 g/cm 2 ), showed annual QCT loss during CEE therapy of ؊11.5 mg/cm 3 ( p < 0.0007) and MPA bone loss of ؊19.7 mg/cm 3 ( p < 0.0001). Losses were marginally greater on MPA than CEE ( p ‫؍‬ 0.04). Extremely high postovariectomy (5 days) and pretreatment resorption markers (>3 SD above premenopausal normal levels) were significantly related to bone loss. Across the year, resorption decreased during CEE but increased on MPA treatment. Significant DXA bone losses were prevented by CEE treatment (؊1.4% FN, ؊.4% WB, and ؊1.5% WBS, all NS). However, DXA bone loss was not prevented by MPA treatment (؊5% FN, ؊2.8% WB, and ؊6.1% WBS, all p < 0.03). Average weight gain was significant (؉3.2 ؎ 4.0 kg) and greater on CEE than MPA (؉4.7 vs. ؉2.0 kg, p ‫؍‬ 0.049). In conclusion, CEE therapy did not prevent significant 8% cancellous spinal bone loss in the first year following premenopausal ovariectomy, despite supplementation with 600 mg/day of calcium, good control of vasomotor symptoms, and nearly 5 kg of gain in weight. Significant DXA bone loss, however, was prevented by CEE, but not by MPA therapy. These unexpected results were statistically related to high bone resorption following ovariectomy, which CEE suppressed but MPA did not. Bone formation markers increased during MPA therapy but were unchanged during CEE

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“…62,64,65 Overall, there is a growing body of evidence that bilateral oophorectomy, particularly before the natural menopause, is associated with greater bone loss and higher rates of osteoporosis and bone fractures. 52,[66][67][68][69][70][71][72] Cognition and central nervous system disease Although the evidence for the effect of menopause on cognition has been conflicting, the data suggest an age-dependent neuroprotective effect of estrogen. 73 For women undergoing surgical menopause before the age of natural menopause, it seems that use of estrogen replacement up until the age of natural menopause may be particularly important.…”

Section: Bone Loss Osteoporosis and Fracture Riskmentioning

confidence: 99%

Surgical Menopause

Rodríguez

Shoupe

2015

Endocrinology and Metabolism Clinics of North America

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In addition to the common symptoms that occur after natural menopause, special considerations apply to women who have had their ovaries removed, particularly when oophorectomy occurs before age 45 years. Women with premenopausal oophorectomy have more severe and prolonged menopausal symptoms. Their risks of adverse mood, heart disease, excessive bone resorption, sexual dysfunction, and cognitive disorders are increased compared with the general population. Retention of the ovaries carries a survival benefit for women at low risk of ovarian malignancy. Women facing oophorectomy should understand the balance of risks and benefits in order to make an informed decision.

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Osteoporosis after Oophorectomy for Non-malignant Disease in Premenopausal Women

Cited by 130 publications

References 10 publications

Ultrasound Measurements of Proximal Phalanges in Polish Early Postmenopausal Women

Ultrasound Measurements of Proximal Phalanges in Polish Early Postmenopausal Women

Premenopausal Ovariectomy-Related Bone Loss: A Randomized, Double-Blind, One-Year Trial of Conjugated Estrogen or Medroxyprogesterone Acetate

Surgical Menopause

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