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).
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.”
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.