Lack of influence of simple premenopausal hysterectomy on bone mass and bone metabolism

OBJECTIVE: Our purpose was to investigate the influence of premenopausal hysterectomy on bone mass.

STUDY DESIGN: A cross-sectional study was performed on 69 women who had premenopausal hysterectomy and 427 women with natural menopause 50 to 59 years old. Bone mineral density was measured in the distal forearm by single-energy x-ray absorptiometry. Body composition and bone mineral density in the anteroposterior spine, proximal femur, and total body was measured by dual-energy x-ray absorptiometry. Bone turnover was determined by plasma osteocalcin, serum alkaline phosphatase, and fasting urinary calcium corrected for creatinine excretion.

RESULTS: Women who had undergone premenopausal hysterectomy had similar bone mineral densities compared with women with an intact uterus in all compartments, apart from a 6% to 11% higher bone mineral density (p < 0.05 to 0.001) in the proximal femur. The women who had undergone premenopausal hysterectomy had 2% to 11% more fat (significant for arm fat, p < 0.05), 9% to 13% lower serum follicle-stimulating hormone levels (p < 0.01), 10% to 13% higher serum estradiol levels (not significant), and 8% to 9% lower osteocalcin levels (p < 0.05 to 0.07). This bone mineral density difference could thus be explained by extragonadal sex hormone production.

CONCLUSION: Premenopausal hysterectomy did not reduce ovarian function and increase bone turnover and bone loss.