title: Surgical menopause and nonvertebral fracture risk among older US women.
abstract: OBJECTIVE
  The aim of this study was to determine whether older postmenopausal women with a history of bilateral oophorectomy before natural menopause (surgical menopause) have a higher risk of nonvertebral postmenopausal fracture than women with natural menopause.
  
  
  METHODS
  We used 21 years of prospectively collected incident fracture data from the ongoing Study of Osteoporotic Fractures, a cohort study of community-dwelling women without previous bilateral hip fracture who were 65 years or older at enrollment, to determine the risk of hip, wrist, and any nonvertebral fracture. χ(2) and t tests were used to compare the two groups on important characteristics. Multivariable Cox proportional hazards regression models stratified by baseline oral estrogen use status were used to estimate the risk of fracture.
  
  
  RESULTS
  Baseline characteristics differed significantly among the 6,616 women within the Study of Osteoporotic Fractures who underwent either surgical (1,157) or natural (5,459) menopause, including mean age at menopause (44.3 ± 7.4 vs 48.9 ± 4.9 y, P < 0.001) and current use of oral estrogen (30.2% vs 6.5%, P < 0.001). Fracture rates were not significantly increased for surgical versus natural menopause, even among women who had never used oral estrogen (hip fracture: hazard ratio [HR], 0.87; 95% CI, 0.63-1.21; wrist fracture: HR, 1.10; 95% CI, 0.78-1.57; any nonvertebral fracture: HR, 1.11; 95% CI, 0.93-1.32).
  
  
  CONCLUSIONS
  These data provide some reassurance that the long-term risk of nonvertebral fracture is not substantially increased for postmenopausal women who experienced premenopausal bilateral oophorectomy, compared with postmenopausal women with intact ovaries, even in the absence of postmenopausal estrogen therapy.
authors.affiliation: Science Programs Department, Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA. Kimberly.k.vesco@kpchr.org
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Vesco
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Marshall
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Nelson
authors.forename: Linda
authors.initials: L
authors.lastname: Humphrey
authors.forename: Joanne
authors.initials: J
authors.lastname: Rizzo
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Pedula
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Marc C
authors.initials: MC
authors.lastname: Hochberg
authors.forename: Diana
authors.initials: D
authors.lastname: Antoniucci
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Hillier
mesh_terms: D000328:Adult; D000368:Aged; D002348:Carpal Bones / Q000293:injuries*; D016009:Chi-Square Distribution; D015914:Estrogen Replacement Therapy; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008593:Menopause; D008594:Menopause, Premature; D008875:Middle Aged; D010052:Ovariectomy; D016016:Proportional Hazards Models; D012307:Risk Factors