A study to evaluate the cause of bone demineralization in gynecological cancer survivors.
BACKGROUND
An association between treatment for gynecological cancers and risk of osteoporosis has never been formally evaluated. Women treated for these cancers are now living longer than ever before, and prevention of treatment-induced morbidities is important. We aimed to distinguish, in gynecological cancer survivors, whether cancer therapy has additional detrimental effects on bone health above those attributable to hormone withdrawal.


METHODS
We performed a retrospective cross-sectional analysis of dual energy x-ray absorptiometry (DEXA) scan results from 105 women; 64 had undergone bilateral salpingo-oophorectomy (BSO) followed by chemotherapy or radiotherapy for gynecological malignancies, and 41 age-matched women had undergone BSO for benign etiologies. All were premenopausal prior to surgery.


RESULTS
The median age at DEXA scan for the cancer group was 42 years, and 66% had received hormonal replacement therapy (HRT) following their cancer treatment. For the benign group, the median age was 40 years, and 87% had received HRT. Thirty-nine percent of cancer survivors had abnormal DEXA scan results compared to 15% of the control group, with the majority demonstrating osteopenia. The mean lumbar spine and femoral neck bone mineral densities (BMDs) were significantly lower in cancer patients. A history of gynecological cancer treatment was associated with significantly lower BMD in a multivariate logistic regression.


CONCLUSIONS
Women treated for gynecological malignancies with surgery and adjuvant chemotherapy have significantly lower BMDs than age-matched women who have undergone oophorectomy for noncancer indications. Prospective evaluation of BMD in gynecological cancer patients is recommended to facilitate interventions that will reduce the risk of subsequent fragility fractures.
Division of Experimental Medicine and Toxicology, Department of Medicine, Imperial College, London, Hammersmith Hospital, London, Uk.
Chara
C
Stavraka
Kate
K
Maclaran
Hani
H
Gabra
Roshan
R
Agarwal
Sadaf
S
Ghaem-Maghami
Alexandra
A
Taylor
Waljit S
WS
Dhillo
Nick
N
Panay
Sarah P
SP
Blagden
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D018488:Bone Demineralization, Pathologic / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology*; D015519:Bone Density / Q000187:drug effects / Q000528:radiation effects; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D010052:Ovariectomy / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects; D017741:Survivors