title: Fracture risk and bone density of peri- and early postmenopausal women with uterine leiomyomas.
abstract: OBJECTIVE
  Fracture risk and bone mineral density (BMD) among peri- and early postmenopausal women with leiomyomas requiring hysterectomy was evaluated.
  
  
  METHODS
  We counted fractures among women with or without leiomyomas using data from the Kuopio Osteoporosis Study. The study population consisted of 6086 women aged 47-56 years with never-use of hormone replacement therapy (HRT) responding to the baseline and 5-year follow-up inquiries. Part of the sample (n=1271) underwent bone densitometry.
  
  
  RESULTS
  Hysterectomy was carried out in 927 women, and 59% reported that this was attributable to leiomyomas. The hazard ratio (HR) was 0.68 (95% CI 0.49-0.94) for any and 0.73 (95% CI 0.43-1.26) for distal forearm fracture among women with leiomyomas compared to those without any. Among women postmenopausal at baseline, the corresponding HRs were 0.62 (95% CI 0.44-0.87) and 0.54 (95% CI 0.31-0.96); after adjusting for age, time since menopause weight, height and previous fracture 0.69 (95% CI 0.49-0.97) and 0.63 (95% CI 0.35-1.11). The baseline BMDs were 1.15 g/cm2 among hysterectomized leiomyoma and 1.12 g/cm2 (ns) among non-hysterectomized women at lumbar (L2-L4), and 0.94 and 0.93 g/cm2 (ns) at femoral sites. The follow-up lumbar BMDs were 1.13 and 1.09 g/cm2 (p<0.001) and the corresponding femoral values were 0.90 and 0.89 g/cm2 (ns), respectively. Among postmenopausal women, the corresponding baseline lumbar BMDs were 1.15 and 1.08 g/cm2 (p<0.001), femoral 0.93 and 0.90 g/cm2 (p=0.003); the follow-up lumbar BMDs 1.13 g/cm2 versus 1.07 g/cm2 (p<0.001); femoral BMDs 0.89 versus 0.87 (ns).
  
  
  CONCLUSIONS
  Peri- and early postmenopausal women with a history of leiomyomas seem to have better BMD and less fractures compared with those without leiomyomas. This may be mediated through higher estrogen levels leading to higher BMD and the growth of leiomyomas.
authors: Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. kaisa.randell@kuh.fi
authors: Kaisa M
authors: KM
authors: Randell
authors: Risto J
authors: RJ
authors: Honkanen
authors: Marjo T
authors: MT
authors: Tuppurainen
authors: Heikki
authors: H
authors: Kröger
authors: Jukka S
authors: JS
authors: Jurvelin
authors: Seppo
authors: S
authors: Saarikoski
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D008875:Middle Aged; D010052:Ovariectomy; D047648:Perimenopause / Q000502:physiology*; D017698:Postmenopause / Q000502:physiology*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014594:Uterine Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery