Anna Gosset1, Claire Escanes1, Jean-Michel Pouilles1, Fabien Vidal2, Yann Tanguy Le Gac2, Geneviève Plu-Bureau3, Florence A Trémollieres1,4. 1. Menopause and Metabolic Bone Disease Center, Hôpital Paule de Viguier, University Hospital of Toulouse, Toulouse, France. 2. Department of Surgical Gynecology, Hôpital Paule de Viguier, University Hospital of Toulouse, Toulouse, France. 3. Gynecological Endocrinology Unit, Hôpital Port-Royal, University of Paris, Paris, France. 4. INSERM U1048-I2MC-Team 9,Toulouse cedex, France.
Abstract
OBJECTIVE: To study bone mineral density (BMD) in women with and without pelvic deep infiltrating endometriosis (DIE) who underwent early bilateral oophorectomy (BO). METHODS: A case-control study was performed in 83 women who underwent early BO before the age of 45 years, 31 for DIE and 52 for another clinical condition. All the women answered a standardized computer-assisted questionnaire to record their clinical and historical data and were medically examined. Lumbar spine and femoral neck BMDs were measured by dual-energy X-ray absorptiometry after early BO. Simultaneously, serum calcium, intact parathyroid, 25-hydroxyvitamin D, and cross-linked C-telopeptide were also measured. Unadjusted and adjusted odds ratios (with 95% confidence intervals [CI]) for endometriosis were calculated using logistic regression. RESULTS: The mean lumbar spine and femoral neck BMDs were significantly higher in women who underwent early BO for DIE than in those who underwent early BO for another clinical condition. After adjusting for age at BMD measurement, years since menopause, age at menarche and body mass index, odds ratio for endometriosis associated with a 1-SD increase in lumbar spine and femoral neck BMD was 2.59 (95% CI: 1.45-4.62) and 2.16 (95% CI: 1.23-3.81), respectively. CONCLUSION: Higher lumbar spine and femoral neck BMDs are associated with an increase in the likelihood of pelvic DIE in women who underwent early BO. This might be expected to the extent that endometriosis is itself associated with enhanced estrogen status, although further studies are needed to confirm such a hypothesis. These findings suggest that BMD measurement could contribute to the hormonal management of surgical menopause in women with DIE.
OBJECTIVE: To study bone mineral density (BMD) in women with and without pelvic deep infiltrating endometriosis (DIE) who underwent early bilateral oophorectomy (BO). METHODS: A case-control study was performed in 83 women who underwent early BO before the age of 45 years, 31 for DIE and 52 for another clinical condition. All the women answered a standardized computer-assisted questionnaire to record their clinical and historical data and were medically examined. Lumbar spine and femoral neck BMDs were measured by dual-energy X-ray absorptiometry after early BO. Simultaneously, serum calcium, intact parathyroid, 25-hydroxyvitamin D, and cross-linked C-telopeptide were also measured. Unadjusted and adjusted odds ratios (with 95% confidence intervals [CI]) for endometriosis were calculated using logistic regression. RESULTS: The mean lumbar spine and femoral neck BMDs were significantly higher in women who underwent early BO for DIE than in those who underwent early BO for another clinical condition. After adjusting for age at BMD measurement, years since menopause, age at menarche and body mass index, odds ratio for endometriosis associated with a 1-SD increase in lumbar spine and femoral neck BMD was 2.59 (95% CI: 1.45-4.62) and 2.16 (95% CI: 1.23-3.81), respectively. CONCLUSION: Higher lumbar spine and femoral neck BMDs are associated with an increase in the likelihood of pelvic DIE in women who underwent early BO. This might be expected to the extent that endometriosis is itself associated with enhanced estrogen status, although further studies are needed to confirm such a hypothesis. These findings suggest that BMD measurement could contribute to the hormonal management of surgical menopause in women with DIE.