Hormone Replacement Therapy Improves Bone Mineral Loss After Salpingo-oophorectomy for Ovarian Cancer

In patients who undergo risk-reducing salpingo-oophorectomy (RRSO), bone mineral density (BMD) screenings are underutilized in spite of the prevalence of bone mineral loss in this population. Hormone replacement therapy (HRT) can address BMD loss in these women, according to a presentation at the 47th Annual Meeting of the Society for Gynecologic Oncology.1

A salpingo-oophorectomy is the removal of an ovary and fallopian tube, resulting in sterility and surgical menopause. An RRSO is an option for women who are at high risk of ovarian cancer, such as women who carry BRCA1/2 mutations.

Emily Prendergast, MD, an obstetrician-gynecologist at Cedars-Sinai Medical Center and University of California, Los Angeles, led the study.

Researchers retrospectively reviewed postsurgical bone health surveillance practices, BMD outcomes, and fracture risk in 192 patients with BRCA1/2 mutations who underwent RRSO between 2000 and 2013. Median age at RRSO was 48 years. Median follow-up was 6.5 years from RRSO surgery. Dual-energy X-ray absorptiometry scan (DEXA) was performed in approximately half (51%) of patients.

Even though nearly two-thirds of women (65%) were premenopausal at RRSO, most of the women (78%, n = 76) had abnormal BMD findings. Osteopenia affected 60% (n = 58) and osteoporosis affected 20% (n = 19) of the women. Age, menopausal status, use of HRT, and length of follow-up were comparable between patients who received DEXA and patients who did not.

The frequency of osteopenia was higher in premenopausal women than in postmenopausal women, whereas osteoporosis was higher in postmenopausal women. In women younger than 50 years, osteopenia and osteoporosis rates were 66% and 11%, respectively, and in postmenopausal women, osteopenia and osteoporosis rates were 50% and 31%, respectively (P = .08).

Median time to abnormal BMD was 24 months, prompting researchers to suggest women who undergo RRSO also undergo BMD screening within 2 years of the procedure.

Women who used HRT experienced lower frequencies of both osteopenia and osteoporosis than women who did not use HRT. HRT usage correlated with an osteopenia rate of 74% and an osteoporosis rate of 0.06%, compared with 83% osteopenia and 22% osteoporosis in non-HRT women (P = .09, odds ration 0.26, CI 0.06-1.22).

“Significant bone loss is common and develops rapidly in women following RRSO. Women with BRCA mutations who undergo RRSO are underscreened for BMD,” concluded the researchers.

“HRT is associated with a lower risk of significant bone loss osteoporosis. Guidelines for screening in these individuals should be firmly established to reduce osteoporotic-related fracture risk in this population.”

Notably, researchers did not record the use of aromatase inhibitors, chemotherapy, or osteoporotic agents.

REFERENCE

1. Prendergast EN, Green M, Zakhour M, et al. Bone density testing underutilized in BRCA population following risk-reducing salpingo-oophorectomy. Presentation at: 47th Annual Meeting of the Society of Gynecologic Oncology; March 19-22, 2016; San Diego, California. Abstract 22.

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