Introduction: Osteoporosis is a common problem of postmenopausal women [1]. It is a manageable disease [2]. Hysterectomy before the onset of menopause is a common gynecological procedure in women of reproductive age [3]. Osteoporosis has substantial burden on economy due to frequently encountered fractures and other problems in post-menopausal women [4]. Deaths associated with osteoporosis has increases over past 10 years [5]. In orthopedics, we come across constitutional symptoms of low back pain and generalized bone and joint pain in young females. The risk of decrease bone mineral density (BMD) in younger female may be associated with hysterectomy. We want to find out the association of decrease bone mineral density in females with early hysterectomy. With early diagnosis, prompt treatment can be started to prevent avoidable riskss of fractures and osteoporosis.
Materials & methods: From March 2015 to June 2017, 152 patients from out-patient department (OPD) between 25 to 40 years of age with post one year of hysterectomy diagnosed on history, examination were included in the study. Informed written consent was taken from every participant in this study. We took plain radiograph and bone marrow density (BMD) amongst patients without documented co-morbidities, joint arthropathies and neurological disorder. We excluded patients with malignancy, current chemotherapy and radiotherapy, renal failure, chronic liver failure past treatment of oral/IV calcium and vitamin D for last three months. Their bone mineral density was evaluated at the spot by taking calcaneum as reference bone. The cutoff value of BMD was taken from previous study [6]. The reference values were taken as T score >1 as indicated as normal BMD, between 1.0 to -1 as low BMD; a score between 1 to -1.8 as a osteopenia and score ≤ 1.8 as osteoporosis. Association of decrease in BMD of females with hysterectomy was evaluated.
Results: Median age of the patient was 37.74 years with Mean±SD (38.0±2.445). Amongst participants, 87 (57.2%) were uneducated, 36 (17.1%) had matric, 14 (9.2%) had intermediate, 17 (11.1%) had graduation and 08 (5.3%) has master degree. Majority 107 (70.4%) has low income (<15000 Pakistani rupees), 33 (21.7%) had middle income (between 15000 to 30000) and only 12 (7.9%) has good income (>30000/month). Majority, 109 (71.7%) has abdominal hysterectomy and 43 928.3%) has vaginal hysterectomy. Amongst the total 152respondents, 94 (61.8%) cover their face and 58 (38.2%) cover their whole body with (Abaya), when they come out of home. Most 116 (76.3%) females were non-smoker and 36 (23.7%) were smoker. Majority 108 (71.1%) said that they were not involved in daily physical activity while 43 (28.3%) were doing regularly. One hundred and thirty-two (86.9%) didn’t sustained any fracture and 20 (13.2%) has sustained fracture after hysterectomy. Amongst 20 patients who sustained fracture, majority 16 (80%) has one bone fractured, three (15%) has two bones while only one patient had three bones fractures. Most 10 patients had (50%) has per-trochanteric bone fractures, 06 (30%) had bones of distal forearm, 04 (20%) had proximal vertebral fractures. When they were asked about use of steroid intake, 123 (80.9%) never used in their life and 29 (19.1%) took steroid in the past. It was alarming, when they were asked about family history of osteoporosis, 132 (86.8%) don’t know and only 20 (13.2%) knew about positive family history of osteoporosis. T-score for BMD was taken, and 60 (39.5%) had normal BMD, 36 (23.7%) has low BMD, 44 (28.9%) had osteopenia and 10 (6.6%) patients had critically low level of osteoporosis.
Discussions: Overall 54 (35.5%) had low BMD with 28.8% osteopenia and 6.6% osteoporosis in our study. Zeidan et al [7] reported 6% osteopenia and 03% osteoporosis while Al-Khobar et al [8] reported 24% osteoporosis and 11.9% osteopenia in females without hysterectomy. Our study has low socio-economic population with majority were uneducated.
Conclusion: We concluded from our study that hysterectomy should be considered as last resort in gynecological problems in younger females. Post-operative risk of osteoporosis should be managed promptly.
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