New Concerns, Risks Associated With Oophorectomy

Decreases in bone mineral density and an increased risk of arthritis may be linked to bilateral oophorectomy, according to new research presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

Anne Marie McCarthy, an epidemiology doctoral candidate at Johns Hopkins Bloomberg School of Public Health, and Dr Kala Visvanathan, associate professor in the Sidney Kimmel Cancer Center and Bloomberg School of Public Health at Johns Hopkins, conducted an analysis of the associations between oophorectomy, arthritis, and bone mineral density as seen in the Third National Health and Nutrition Examination Survey (NHANES III). McCarthy presented their findings at the meeting.

The analysis included women aged 40 years or older who had no history of cancer and either had bilateral oophorectomy or intact ovaries. In total, 3,600 women were included in the bone mineral density analysis and 4,039 women were included in the arthritis analysis.

Dual-energy X-ray was used to measure bone mineral density in the femoral neck of participants. To determine prevalence of arthritis, women were asked if they had ever been diagnosed with the disease. History of hormone replacement therapy use was also obtained.

Compared to women who had intact ovaries, McCarthy and Visvanathan found that women who had both ovaries removed before the age of 45 had lower age-standardized mean femoral neck bone mineral density than their counterparts with intact ovaries (0.711 g/cm2 and 0.743 g/cm2, respectively).

McCarthy and Visvanathan also found an increased prevalence of arthritis diagnoses among women who had both ovaries removed. Specifically, 45.4% of women with history of bilateral oophorectomy had reported arthritis while only 32.1% of women with intact ovaries reported such a diagnosis. The prevalence of arthritis increased among those women who had oophorectomy before 45 years of age; the researchers found that 47.7% of these women reported arthritis.

In their multivariate analysis looking at odds ratios, the researchers found that women who had oophorectomy had increased odds of having arthritis as compared to women with intact ovaries; they found this to be especially true for women who had oophorectomy at or before age 45. Moreover, the odds ratio was even greater when women who had used hormone replacement therapy were excluded from analysis.

While their study points to an important association, McCarthy and Visvanathan could not determine causality since NHANES III was a cross-sectional study. Nevertheless, the clinical importance of their work is evident.

“Our study suggests that some women with oophorectomy, particularly at a young age, can experience clinically relevant decreases in bone mineral density,” McCarthy reported. “Clinicians need to be aware of this so they can intervene early if required.”

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References:

Reference
McCarthy AM, Visvanathan K. Bilateral oophorectomy is associated with a higher prevalence of arthritis and lower bone mineral density in women 40 years and older (P4-11-01). Presented at: 2011 CTRC-AACR San Antonio Breast Cancer Symposium; December 2011; San Antonio.