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Randomized controlled trial of the effect of hysterectomy or LNG-IUS use on bone mineral density: a five-year follow-up

Karoliina H Halmesmaki, Jorma A Paavonen, Marjo T Tuppurainen and Ritva A Hurskainen

In the treatment of menorrhagia, levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena^®) is compared with hysterectomy in terms of bone mineral density (BMD). In the lumbar spine, BMD decreased among hysterectomized women, but not among LNG-IUS users. Background: Osteoporosis is an increasing health problem. Osteoporotic fractures cause excess mortality, morbidity and heavy costs. Hysterectomy and LNG-IUS are the most effective treatment modalities for menorrhagia. However, the effect of these treatment modalities on BMD has not been compared. Design: Randomized controlled trial. Participants: 107 healthy women, aged 35–49, referred for menorrhagia. Interventions: Of the women, 54 were randomized to hysterectomy and 53 to the LNG-IUS group. Outcome measures: Bone mineral density measured by dual X-ray absoptiometry from the lumbar spine and the femoral neck at baseline and 5 years after randomization. Results: The two groups did not differ in terms of age, parity, body mass index, serum follicle-stimulating hormone, smoking, alcohol use, physical activity or daily calcium intake. There was no statistical significant difference in BMD between the treatment arms. However, lumbar spine BMD decreased significantly in the hysterectomy group but not in the LNG-IUS group. The change in BMD was not explained by factors included in the linear regression model. The BMD change in the femoral neck was similar in both arms. Conclusions: Hysterectomy may accelerate age-related loss in BMD, but studies with longer follow-up are needed.