Hysterectomy without adnexal surgical procedure raises osteoporosis risk


A recent study reveals that hysterectomy without an adnexal surgical procedure increases the risk of osteoporosis among women aged 40 to 59 years, emphasizing the need for informed patient consultation regarding this potential association.

Hysterectomy without adnexal surgical procedure raises osteoporosis risk | Image Credit: © eddows - © eddows - stock.adobe.com.

Hysterectomy without adnexal surgical procedure raises osteoporosis risk | Image Credit: © eddows - © eddows - stock.adobe.com.

Osteoporosis risk is increased by hysterectomy without an adnexal surgical procedure, according to a recent study published in JAMA Network Open.


  1. Hysterectomy without an adnexal surgical procedure is associated with an elevated risk of osteoporosis, as revealed by a cohort study involving female patients aged 40 to 59 years.
  2. Osteoporosis is reported in approximately 19.2% of patients who underwent hysterectomy compared to 16.9% in the nonhysterectomy group. The 7-year risk of osteoporosis is higher in patients with hysterectomy, indicating a potential correlation.
  3. While osteoporosis risk is elevated, the study did not find a significant difference in fracture risks between the hysterectomy and nonhysterectomy groups, suggesting that hysterectomy may specifically impact bone health without necessarily increasing the risk of fractures.
  4. The study identified age-related trends, with a higher risk of osteoporosis observed in patients aged 40 to 49 years with hysterectomy and no adnexal surgical procedure. This trend was also seen in patients aged 50 to 59 years.
  5. The study suggests that patients undergoing hysterectomy, especially those without an adnexal surgical procedure, may benefit from being informed about the potential association with increased osteoporosis risk.

Osteoporosis is a bone disease associated with reduced bone mineral density (BMD), poor bone quality, decreased bone mass, and microstructural destruction, and is reported in 15.4% to 16.5% of US women aged over 50 years. Among older women, osteoporosis-related fractures are the leading cause of medical costs, disability, and death.

Hysterectomy is a common procedure among US women, with over half of hysterectomies in the United States being performed alongside bilateral oophorectomy, a known risk factor for osteoporosis. However, it is unclear how hysterectomy alone impacts osteoporosis risk when considering other risk factors such as body mass index, smoking, alcohol use, and menopausal status.

To determine osteoporosis risk following hysterectomy with or without an adnexal surgical procedure, investigators conducted a cohort study using data from the National Health Insurance Service (NHIS). The NHIS includes demographic data and provides comprehensive health screening service at no cost to individuals residing in South Korea.

A hysterectomy and nonhysterectomy group were created, both including female patients aged 40 to 59 years. Patients in the hysterectomy group had their uterus removed because of benign factors from 2002 to 2011, while those in the nonhysterectomy group had an NHIS health checkup within the same timeframe.

BMD test codes and osteoporosis diagnosis codes were used to determine osteoporosis in patients. Patients were classified based on fracture type. Covariates included age, socioeconomic status, alcohol drinking, smoking, and physical activity.

In the final analysis, 12,955 patients with hysterectomy were matched to 12,955 controls. Patients were aged a median 47 years and were followed for a median 10.9 years. A hysterectomy without an adnexal surgical procedure was reported in 83% of patients and a hysterectomy with an adnexal surgical procedure in 17%.

Menopausal hormone therapy was reported in 4.1% of the hysterectomy group and 1.5% of the nonhysterectomy group. Osteoporosis was reported in 19.2% of the hysterectomy group vs 16.9% of the nonhysterectomy group, but fractures were reported in 21.1% vs 21.4%.

Overall, the 7-year risk of osteoporosis was greater in patients with hysterectomy compared to those without hysterectomy, with hazard ratios (HRs) of 1.56 and 1.28, respectively in patients with vs without an adnexal surgical procedure.Fracture risks did not significantly differ based on adnexal surgical procedure in the hysterectomy group.

A higher risk of osteoporosis within 7 years was observed among patients aged 40 to 49 years with a hysterectomy but no adnexal surgical procedure, with an HR of 1.42. Osteoporosis risk was also significantly increased in patients aged 50 to 59 years with these conditions, with an HR of 1.17. Fracture risk was not significantly impacted in either group.

In the hysterectomy group, osteoporosis had an incidence of 177 per 10,000 person-years vs 157 per 10,000 person-years in the nonhysterectomy group. Osteoporosis risk was increased in patients with a hysterectomy and adnexal surgical procedure regardless of duration.

These resultsindicated higher osteoporosis risk in patients with a hysterectomy but not an adnexal surgical procedure, but no significant difference in risk after 7 years. Investigators concluded patients should be consulted about this potential association.


Seo Y, Yuk J. Osteoporosis and fracture risk following benign hysterectomy among female patients in Korea. JAMA Netw Open. 2023;6(12):e2347323. doi:10.1001/jamanetworkopen.2023.47323

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