Hysterectomy, oophorectomy, and bone health: a systematic review and meta-analysis
Bibliographic record
Abstract
OBJECTIVE: To review the association between hysterectomy, with and without oophorectomy, and fracture, osteoporosis, and bone mineral density (BMD) change. METHODS: We undertook a systematic review and meta-analysis, searching PubMed, Embase, Cochrane Central, and CINAHL from inception to November 2024. Eligible studies included women aged ≥18 years and assessed the relationship between having a hysterectomy and/or oophorectomy and fracture, osteoporosis, or BMD. RESULTS: Of 15 305 articles screened, 29 met the inclusion criteria, with 19 included in the meta-analyses. Bilateral oophorectomy compared to no oophorectomy was associated with a higher risk of fracture (pooled relative risk [RR] 1.17, 95% CI 1.03-1.33, 10 studies) and osteoporosis, although the latter was not statistically significant (RR 1.46, 95% CI 0.94-2.27, 4 studies). Hysterectomy with bilateral oophorectomy was not associated with a higher fracture risk compared to hysterectomy without oophorectomy (RR 0.99; 95% CI 0.83-1.18, 4 studies). However, hysterectomy without oophorectomy compared to no surgery was associated with a higher osteoporosis risk (RR 1.45; 95% CI 1.37-1.53, 2 studies). Findings showed moderate to high heterogeneity, and most studies did not account for variables such as age at surgery, menopausal hormone therapy use, and indications for surgery. CONCLUSIONS: Our review supports evidence showing that bilateral oophorectomy is negatively associated with bone health and suggests that hysterectomy alone may also increase osteoporosis risk, although more data are required. To support personalised clinical decision-making, further large-scale longitudinal studies with longer follow-up and detailed assessment of surgery extent, timing, and medication use are essential.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.015 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".