Osteoporosis

Oophorectomy May Be Tied to Bone Loss After Surgery

Routine bone mineral density (BMD) assessment and hormone therapy may play key roles postoperatively in bilateral salpingo-oophorectomy recipients with a BRCA mutation, especially in those who are premenopausal at the time of surgery.1 New findings published in JAMA Network Open suggest that the procedure may be associated with postoperative bone loss in this patient population, but that hormone therapy use may help mitigate this risk.1

Researchers arrived at this conclusion following a retrospective cohort study of 95 women (mean age at oophorectomy: 48.0 years) with a BRCA mutation who underwent oophorectomy through Toronto’s University Health Network in Canada. In addition to a BRCA mutation, all participants in the study had at least 1 ovary intact before surgery and no cancer history other than breast cancer. Mean follow-up lasted 22 months.

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The study’s main outcome was defined as the annual change in bone mineral density (BMD) in the lumbar spine, femoral neck, and total hip from baseline to follow-up. Pre- and post-surgery BMD was measured via dual-energy x-ray absorptiometry.

From baseline to follow-up, women who were premenopausal at the time of oophorectomy (n= 50) had experienced a decrease in BMD across the lumbar spine, femoral neck, and total hip, with annual changes in BMD of -3.45%, -2.85%, and -2.24%, respectively.

However, the researchers noted, participants who reported using hormone therapy had significantly less bone loss at the lumbar spine (-2.00% vs -4.69%) and total hip (-1.38% and -3.21%) compared with those who did not use hormone therapy.

A significant decrease in BMD was also observed in postmenopausal women (n= 45) across the lumbar spine and femoral neck (annual change -0.82% and -0.68%, respectively), but not the total hip (annual change -0.18%).

Ovarian Cancer Risk and Prophylactic Strategies

Salpingo-oophorectomy is a recommended prophylactic strategy in carriers of BRCA1 or BRCA2 mutations, which are known to be associated with a higher lifetime risk for ovarian cancer.2,3 Of the 21,000 women per year who receive a diagnosis of ovarian cancer, approximately 2100 (10%) have a BRCA1 or BRCA2 mutation.2

For women with BRCA mutations, National Comprehensive Cancer Network Guidelines for ovarian cancer risk management include the following recommendations:3

  • Risk-reducing salpingo-oophorectomy is recommended between age 35 and 40 years and upon completion of child bearing.
  • Since the average age of ovarian cancer onset is 8 to 10 years later in BRCA2 mutation carriers than in BRCA1 mutation carriers, delay of risk-reducing salpingo-oophorectomy until age 40 to 45 years is “reasonable” for those with a BRCA2 mutation.


—Christina Vogt

References:

1. Kotsopoulos J, Hall E, Finch A, et al. Changes in bone mineral density after prophylactic bilateral salpingo-oophorectomy in carriers of a BRCA mutation. JAMA Netw Open. 2019;2(8):e198420. doi:10.1001/jamanetworkopen.2019.8420.

2. Does breast or ovarian cancer run in your family? Hereditary breast and ovarian cancer. Centers for Disease Control and Prevention. https://www.cdc.gov/genomics/disease/breast_ovarian_cancer/breast_cancer.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffeatures%2Fhereditarycancer%2Findex.html. Page last reviewed July 5, 2019. Accessed August 9, 2019.

3. NCCN guidelines for risk management for women with BRCA mutations. Hereditary cancer info. FORCE. https://www.facingourrisk.org/understanding-brca-and-hboc/information/risk-management/introduction/basics/nccn_guidelines_for_women_with_brca.php. Accessed August 9, 2019.