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Surgical Menopause and Frailty Risk in Community‐Dwelling Older Women: Study of Osteoporotic Fractures
Author(s) -
Huang Grace,
Coviello Andrea,
LaValley Michael P.,
Ensrud Kristine E.,
Cauley Jane A.,
Cawthon Peggy M.,
Fredman Lisa
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15505
Subject(s) - medicine , menopause , surgical menopause , body mass index , odds ratio , prospective cohort study , confidence interval , cohort study , oophorectomy , gynecology , gerontology , surgery , hysterectomy
Objectives To determine whether women with surgical menopause have a higher risk of frailty than naturally menopausal women. Design Prospective cohort study with up to 18 years of follow‐up. Setting Four U.S clinical centers. Participants Community‐dwelling white women aged 65 and older (mean 71.2±5.2) enrolled in the Study of Osteoporotic Fractures (N=7,699). Measurements Surgical menopause was based on participant self‐report of having undergone bilateral oophorectomy before menopause. The outcome was incident frailty, classified as robust, prefrail, frail, or death at 4 follow‐up interviews, conducted 6 to 18 years after baseline. Information on baseline serum total testosterone concentrations was available for 541 participants. Results At baseline, 12.6% reported surgical menopause. Over the follow‐up period, 22.0% died, and 10.1% were classified as frail, 39.7% as prefrail, and 28.3% as robust. Surgically menopausal women had significantly lower total serum testosterone levels (13.2 ± 7.8 ng/dL) than naturally menopausal women (21.7 ± 14.8 ng/dL) (p=0.000), although they were not at greater risk of frailty (adjusted odds ratio (aOR)=0.94, 95% confidence interval (CI)=0.72–1.22), prefrailty (aOR=0.96, 95% CI=0.80–1.10), or death (aOR=1.17, 95% CI=0.97–1.42) after adjusting for age, body mass index, and number of instrumental activity of daily living impairments. There was no evidence that oral estrogen use modified these associations. Conclusion In postmenopausal women, surgical menopause was not associated with greater risk for frailty than natural menopause, even in the absence of estrogen therapy. Future prospective studies are needed to investigate hormonal mechanisms involved in development of frailty in older postmenopausal women. J Am Geriatr Soc 66:2172–2177, 2018.