Despite being at a greater risk for bone loss after prophylactic oophorectomy, carriers of BRCA mutations are under-screened for bone mineral density, according to a recent study.
Women with BRCA1 or BRCA2 have a significantly increased risk of developing breast and ovarian cancer. For this reason, some patients opt for preventative oophorectomy, the surgical removal of the ovaries, which can reduce one’s risk for both ovarian and breast cancer but also can adversely affect bone mineral density.
Researchers from Cedars-Sinai Medical Center (Los Angeles, CA) conducted a study to evaluate bone health surveillance patterns, bone mineral density outcomes, and fracture risk after risk-reducing salpingo-oophorectomy (RRSO) in 192 patients with BRCA mutations. Emily N Prendergast, MD, presented the study’s results at the Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (March 19-22, 2016; San Diego CA).
The primary outcome measure was the number of patients who had a dual-energy X-ray absorptiometry (DEXA) scan after surgery, but the research team also looked at new diagnoses, time to diagnosis of osteopenia and osteoporosis, and incidence of fracture. Information regarding the use of hormone replacement therapy (HRT) was also recorded.
The median age of patients was 48 years, and approximately 65% were premenopausal at the time of surgery. Median follow-up was 6.5 years after RRSO date.
In total, DEXA scans were used on 97 patients (51%) after RRSO, 48 of whom had 1 or more test. Seventy-six patients (78%) had abnormal findings, 58 (60%) had osteopenia, and 19 (20%) had osteoporosis. Compared with patients younger than 50 years of age, postmenopausal patients had a lower rate of osteopenia (50% vs 66%), but a higher rate of osteoporosis (31% vs 11%). And only 10 patients (5%) reported fractures.
However, the use of HRT may reduce osteopenia and osteoporosis risk. A total of 35 patients (46%) who underwent DEXA reported using HRT and, compared with women who did not use HRT, these patients experienced lower rates of osteopenia (74% vs 83%) and osteoporosis (0.06% vs 22%).
From these data, researchers concluded that significant bone loss is common and develops rapidly in patients after undergoing RRSO, though HRT can reduce the risk of bone-loss osteoporosis. Dr Pendergast ended her presentation by calling for the development of guidelines for screening patients with BRCA mutations for bone loss to reduce the risk of osteoporotic-related fracture in this patient population.
