Bone density scans underutilized after prophylactic oophorectomy

Despite that carriers of BRCA mutations who undergo prophylactic oophorectomy are at risk for bone loss, these women are underscreened for bone mineral density, according to study results presented at the Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.

However, the use of hormone-replacement therapy lowered the risk for significant bone loss osteoporosis, results showed.

Emily N. Prendergast, MD, an obstetrician-gynecologist at Cedars-Sinai Medical Center and University of California, Los Angeles, and colleagues sought to characterize bone health surveillance patterns, bone mineral density outcomes and fracture risk after risk-reducing salpingo-oophorectomy in 192 women with BRCA mutations.

Median age at time of surgery was 48 years. Approximately 65% of women were premenopausal at time of surgery.

The number of women who underwent dual-energy x-ray absorptiometry scan (DEXA) after oophorectomy served as the primary outcome measure. Secondary outcome measures included new diagnoses, time to diagnosis of osteopenia and osteoporosis, and the incidence of fracture.

Median follow-up was 6.5 years.

Overall, 97 women (51%) underwent DEXA after oophorectomy. Forty-eight of them underwent one or more scans.

Seventy-six women (78%) had abnormal results, which included 58 (60%) who had osteopenia and 19 (20%) who had osteoporosis. The median time to an abnormal bone density was 24 months (range, 1-151).

Ten women (5%) experienced fracture. Compared with postmenopausal women, women aged younger than 50 years had a higher rate of osteopenia (66% vs. 50%) and a lower rate of osteoporosis (11% vs. 31%).

Thirty-five women (46%) who underwent DEXA reported use of hormone-replacement therapy. A smaller proportion of women who used hormone therapy experienced osteopenia (74% vs. 83%) and osteoporosis (0.06% vs. 22%) compared with women who did not use hormone therapy (OR = 0.26; 95% CI, 0.06-1.22).

Based on these data, women should obtain a bone mineral density test within 2 years of oophorectomy and then again every 2 years thereafter, the researchers wrote.

“Guidelines for screening in these individuals should be firmly established to reduce osteoporotic-related fracture risk in this population,” Prendergast and colleagues wrote. “There are a variety of other approaches to the prevention of osteoporosis such as bisphosphonates, diet and exercise. We should be offering this to our patients regardless of whether or not they are offered hormone-replacement therapy.” – by Jennifer Southall

Reference:

Prendergast EN, et al. Abstract 140. Presented at: Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer; March 19-22, 2016; San Diego.

Disclosure: The researchers report no relevant financial disclosures.