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Summary <p>Women at high familial risk for ovarian cancer are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO), leading to surgical menopause and short-term bone loss. However, long-term studies and osteoporosis screening recommendations are lacking. Eighteen years after premenopausal RRSO, women had lower bone mineral density compared with women who underwent a postmenopausal RRSO.</p> Purpose <p>To prevent ovarian cancer, <i>BRCA1/2</i> germline pathogenic variant carriers are recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO). Premenopausal RRSO leads to immediate menopause, which has been associated with an acute phase of rapid bone loss. However, data on long-term bone mineral density (BMD) is scarce and inconclusive. We aimed to investigate long-term BMD after premenopausal RRSO.</p> Methods <p>We conducted a cross-sectional study nested in a nationwide cohort of women at high familial risk of ovarian cancer. We compared 493 women who underwent premenopausal RRSO (≤ 45&#xa0;years) with 228 women who underwent postmenopausal RRSO (≥ 54&#xa0;years). BMD was assessed by Dual-Energy X-ray absorptiometry of the lumbar spine (LS) and femoral neck (FN). Age differences between the pre- and postmenopausal RRSO groups were accounted for using Z-scores.</p> Results <p>Median age at study visit was 59.2&#xa0;years in the premenopausal RRSO group and 69.7&#xa0;years in the postmenopausal RRSO group (<i>P</i> &lt; 0.001), median time since premenopausal RRSO was 18.1&#xa0;years (IQR 15.3–21.3). In multivariable regression analyses the BMD Z-scores of the LS and FN were significantly lower for the premenopausal compared with the postmenopausal RRSO group (β -0.88, 95% CI, -1.10,-0.66 for LS; β -0.51, 95% CI, -0.71,-0.31 for FN). Relative risks (RRs) of having a Z-score ≤ -1.0 were also higher in the premenopausal compared with the postmenopausal RRSO group (RR 2.35, 95% CI, 1.26–4.40 and RR 1.84, 95% CI, 1.08–3.13, respectively).</p> Conclusion <p>Premenopausal RRSO appears to be associated with long-term lowering of BMD Z-scores, emphasizing the importance of counseling women about bone health after premenopausal RRSO.</p> Clinical trial registration <p>The pre-registered clinical trial number is &lt; NCT03835793 &gt; </p>

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Long-term effects of premenopausal risk-reducing salpingo-oophorectomy on bone mineral density

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月4日

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  • Maarten J. Beekman,
  • Lara Terra,
  • Anniek Stuursma,
  • Bernadette A. M. Heemskerk-Gerritsen,
  • Jeanine E. Roeters van Lennep,
  • Marc van Beurden,
  • Lena C. van Doorn,
  • Joanne A. de Hullu,
  • Eleonora B. L. van Dorst,
  • Constantijne H. Mom,
  • Brigitte F. M. Slangen,
  • Christina Mitea,
  • Riemer H. J. A. Slart,
  • Miranda M. Snoeren,
  • Marcel P. Stokkel,
  • Hein J. Verberne,
  • Bart de Keizer,
  • Catharina M. Korse,
  • Katja N. Gaarenstroom,
  • Klaartje van Engelen,
  • Lizet E. van der Kolk,
  • J. Margriet Collée,
  • Marijke R. Wevers,
  • Margreet G. E. M. Ausems,
  • Lieke P. V. Berger,
  • Encarna B. Gomez Garcia,
  • Christi J. van Asperen,
  • Maartje J. Hooning,
  • Angela H. E. M. Maas,
  • Marian J. E. Mourits,
  • Flora E. van Leeuwen,
  • M. Carola Zillikens

摘要

Summary

Women at high familial risk for ovarian cancer are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO), leading to surgical menopause and short-term bone loss. However, long-term studies and osteoporosis screening recommendations are lacking. Eighteen years after premenopausal RRSO, women had lower bone mineral density compared with women who underwent a postmenopausal RRSO.

Purpose

To prevent ovarian cancer, BRCA1/2 germline pathogenic variant carriers are recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO). Premenopausal RRSO leads to immediate menopause, which has been associated with an acute phase of rapid bone loss. However, data on long-term bone mineral density (BMD) is scarce and inconclusive. We aimed to investigate long-term BMD after premenopausal RRSO.

Methods

We conducted a cross-sectional study nested in a nationwide cohort of women at high familial risk of ovarian cancer. We compared 493 women who underwent premenopausal RRSO (≤ 45 years) with 228 women who underwent postmenopausal RRSO (≥ 54 years). BMD was assessed by Dual-Energy X-ray absorptiometry of the lumbar spine (LS) and femoral neck (FN). Age differences between the pre- and postmenopausal RRSO groups were accounted for using Z-scores.

Results

Median age at study visit was 59.2 years in the premenopausal RRSO group and 69.7 years in the postmenopausal RRSO group (P < 0.001), median time since premenopausal RRSO was 18.1 years (IQR 15.3–21.3). In multivariable regression analyses the BMD Z-scores of the LS and FN were significantly lower for the premenopausal compared with the postmenopausal RRSO group (β -0.88, 95% CI, -1.10,-0.66 for LS; β -0.51, 95% CI, -0.71,-0.31 for FN). Relative risks (RRs) of having a Z-score ≤ -1.0 were also higher in the premenopausal compared with the postmenopausal RRSO group (RR 2.35, 95% CI, 1.26–4.40 and RR 1.84, 95% CI, 1.08–3.13, respectively).

Conclusion

Premenopausal RRSO appears to be associated with long-term lowering of BMD Z-scores, emphasizing the importance of counseling women about bone health after premenopausal RRSO.

Clinical trial registration

The pre-registered clinical trial number is < NCT03835793 >