Revista de Geopolítica · Sep 22, 2026
PREMATURE OVARIAN INSUFFICIENCY AFTER BILATERAL OOPHORECTOMY: LONG-TERM SKELETAL OUTCOMES AND FRACTURE RISK
By ALVES GPW, da Costa PSS, Rivera JFCDMB et al.
Introduction: Bilateral oophorectomy performed before natural menopause causes an abrupt and permanent reduction in ovarian sex-steroid production. When performed before 40 years of age, it constitutes iatrogenic premature ovarian insufficiency; procedures performed between 40 and 44 years are more accurately classified as early surgical menopause. Estrogen deprivation accelerates bone remodeling, decreases bone mineral density, and may increase lifetime fracture risk. Objective: To evaluate short- and long-term skeletal outcomes after premenopausal bilateral oophorectomy, with emphasis on bone mineral density, bone strength, osteoporosis, fracture risk, and the modifying effect of hormone therapy. Methods: A structured integrative review was conducted using PubMed/MEDLINE and supplementary citation tracking for studies available through August 2026. Cohort studies, controlled longitudinal studies, systematic reviews, meta-analyses, and clinical guidelines evaluating skeletal outcomes after bilateral oophorectomy or risk-reducing salpingo-oophorectomy were considered. Evidence from spontaneous premature ovarian insufficiency was used only as contextual support. Owing to heterogeneity in surgical indications, age, hormone therapy exposure, outcomes, and follow-up duration, findings were synthesized narratively. Results: Prospective cohorts consistently demonstrated accelerated bone loss during the first two to three years after surgery. Lumbar spine bone mineral density generally declined by approximately 3% to 6%, with clinically relevant losses also occurring at the hip and femoral neck. Hormone therapy reduced but did not always eliminate this decline. A nationwide cohort found lower lumbar spine and femoral neck age-adjusted bone density more than 18 years after premenopausal risk-reducing surgery. Fracture results were less consistent. A Danish cohort found no statistically significant increase after surgery before age 51, whereas a United States cohort reported higher odds of fractures after oophorectomy before age 46. A recent meta-analysis estimated a modest increase in fracture risk after bilateral oophorectomy compared with ovarian conservation. Conclusion: Accelerated bone loss after premenopausal bilateral oophorectomy is well supported, particularly at the lumbar spine. The magnitude of the long-term fracture risk remains less certain but appears to depend on age at surgery, duration of estrogen deprivation, hormone therapy exposure, cancer treatment, and conventional skeletal risk factors. Early hormone replacement when not contraindicated, baseline bone-density assessment, individualized surveillance, and long-term prevention strategies are essential.