title: Bone mineral density and fractures after risk-reducing salpingo-oophorectomy in women at increased risk for breast and ovarian cancer.
abstract: OBJECTIVE
  Risk-reducing salpingo-oophorectomy (RRSO) reduces ovarian cancer risk in BRCA mutation carriers. RRSO is assumed to decrease bone mineral density (BMD) and increase fracture risk more than natural menopause. We aimed to compare BMD and fracture incidence after premenopausal RRSO to general population data and identify risk factors for low BMD and fractures after RRSO.
  
  
  METHODS
  In 212 women with RRSO at premenopausal age, BMD was measured by dual energy X-ray absorptiometry. Fractures and risk factors were assessed by self-administered questionnaire. Fracture incidence after RRSO was compared to general practitioner data by using standardised incidence ratios (SIRs). Risk factors for low standardised BMD-scores and fractures were identified by regression analyses.
  
  
  RESULTS
  Median age at RRSO was 42years (range 35-65) and duration of follow-up 5years (2-8). Standardised lumbar spine (Z=0.01, p=0.870) and femoral neck BMD (Z=0.15, p=0.019) were not lower than population BMD. Higher age at time of RRSO and use of hormonal replacement therapy were associated with higher, and current smoking with lower standardised BMD-scores. Sixteen women reported 22 fractures. Fracture incidence was not higher than expected from the general population (all fractures: 25-44years: SIR 2.12 [95% confidence interval (CI) 0.85-4.37]; 45-64years: SIR 1.65 [95% CI 0.92-2.72]).
  
  
  CONCLUSIONS
  Five years after RRSO, BMD and fracture incidence were not different than expected from the general population. Based on these data it appears safe not to intensively screen for osteoporosis within five years after RRSO, although prospective research on the long-term effects of RRSO on bone is warranted.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands. Electronic address: i.e.fakkert@umcg.nl.
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Fakkert
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Geriatric Medicine, Groningen, The Netherlands. Electronic address: e.m.abma@umcg.nl.
authors.forename: Elske Marije
authors.initials: EM
authors.lastname: Abma
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Vascular Medicine, Groningen, The Netherlands. Electronic address: iriswestrik@gmail.com.
authors.forename: Iris G
authors.initials: IG
authors.lastname: Westrik
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Vascular Medicine, Groningen, The Netherlands. Electronic address: j.d.lefrandt@umcg.nl.
authors.forename: Joop D
authors.initials: JD
authors.lastname: Lefrandt
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands. Electronic address: b.h.r.wolffenbuttel@umcg.nl.
authors.forename: Bruce H R
authors.initials: BH
authors.lastname: Wolffenbuttel
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands. Electronic address: j.c.oosterwijk@umcg.nl.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Oosterwijk
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, The Netherlands. Electronic address: r.h.j.a.slart@umcg.nl.
authors.forename: Riemer H J A
authors.initials: RH
authors.lastname: Slart
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, The Netherlands. Electronic address: e.van.der.veer@umcg.nl.
authors.forename: Eveline
authors.initials: E
authors.lastname: van der Veer
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands. Electronic address: g.h.de.bock@umcg.nl.
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Gynaecology, Groningen, The Netherlands. Electronic address: m.j.e.mourits@umcg.nl.
authors.forename: Marian J E
authors.initials: MJ
authors.lastname: Mourits
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density; D001943:Breast Neoplasms / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000209:etiology / Q000517:prevention & control*; D010052:Ovariectomy / Q000379:methods; D012307:Risk Factors; D040242:Risk Reduction Behavior; D058994:Salpingectomy
keywords: Bone; Fractures; Genes, BRCA1, BRCA2; Osteoporosis; Ovariectomy