Bone Loss Likely After Prophylactic Bilateral Salpingo-Oophorectomy

Uterus and ovaries genital female surgery concept. Model of uterus and ovaries near scalpel, surgical gloves and blood test tube with blood result. Indications for surgery or surgical operation
Premenopausal women who undergo prophylactic bilateral salpingo-oophorectomy are especially prone to postoperative bone loss, which may be mitigated by hormone replacement therapy.

Premenopausal women who undergo prophylactic bilateral salpingo-oophorectomy are especially prone to postoperative bone loss, according to study results published in JAMA Network Open.

To determine whether an association exists between prophylactic bilateral salpingo-oophorectomy and bone mineral density (BMD) loss, researchers conducted a retrospective cohort study of 95 women (mean age, 48.0 years) with a BRCA1 or BRCA2 mutation who underwent an oophorectomy to prevent ovarian cancer and improve overall survival.

Mean follow-up duration was 22.0 months, with annual change of BMD from baseline to follow-up measured at the lumbar spine, femoral neck, and total hip.

Among patients who were premenopausal at surgery (n=50; 53%), BMD significantly decreased annually at the lumbar spine (-3.45%), femoral neck (-2.85%), and total hip (-2.24%). Although not as substantially as premenopausal women, those who were postmenopausal at surgery also experienced a significant annual BMD decrease at the lumbar spine (-0.82%) and femoral neck (-0.68%), but not at the total hip (-0.18%). Proportions of women classified as having osteopenia and osteoporosis before surgery (41% and 4%, respectively) increased significantly after surgery (54% and 6%, respectively; P <.001).

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After surgery, there was a significant increase in the proportion of women who used hormone therapy (from 3% to 28%; P <.001). Compared with premenopausal women who did not use hormone therapy, those who reported hormone therapy use were found to have significantly less bone loss at the lumbar spine (-4.69% vs -2.00%; P =.02) and total hip (-3.21% vs -1.38%; P =.04).

Limitations to this study included its small sample size and relatively short follow-up period.

In summarizing their findings, the researchers said, “[t]he high rates of bone loss confirm the adverse effect of instantaneous hormone loss associated with surgical menopause. Importantly, the mitigating effect of [hormone therapy] use (and potentially [selective estrogen receptor modulators] use) must be considered when establishing guidelines for the management of this high-risk population with unique needs.”

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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.