Bone loss in women with BRCA1 and BRCA2 mutations

Powell, C. Bethan; Alabaster, Amy; Stoller, Nicole E.; Armstrong, Mary Anne; Salyer, Chelsea; Hamilton, I.; Raine‐Bennett, Tina

doi:10.1016/j.ygyno.2018.01.013

Cited by 13 publications

(12 citation statements)

References 14 publications

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“…Reported incidence of osteoporosis and osteopenia diagnosed on DEXA scans in BRCA carriers following RRSO (both pre and post-menopausal) is 8-14% and 23-57% respectively (table-2). 6,65,[79][80][81][82] Pre-menopausal RRSO in BRCA carriers using E-HRT (oestrogen-HRT) is not associated with an increased risk of osteoporosis/osteopenia. Challberg et al in a retrospective cohort study, found the incidence of osteoporosis and osteopenia to be higher in BRCA carriers with no E-HRT use after premenopausal RRSO in comparison to women who took E-HRT (osteoporosis: 13% vs 3%, osteopenia:…”

Section: Bone Healthmentioning

confidence: 99%

Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers

Gaba

Manchanda

2020

Best Practice & Research Clinical Obstetrics & Gynaecol

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Section: Bone Healthmentioning

confidence: 99%

Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers

Gaba

Manchanda

2020

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…Facing the decision of oophorectomy, women are concerned about the effects of early surgical menopause and want to know how RRSO will likely affect their overall well‐being, and specifically their physical, emotional and sexual function. In order to appropriately counsel women regarding the relative benefit of cancer risk reduction and the health consequences of RRSO, it is important to understand the impact of pre‐versus postmenopausal RRSO relative to other factors such as age, cancer and cancer treatment on sexual and menopausal symptoms and to be able to provide realistic expectations regarding immediate post‐operative versus long‐term impact. As expected, RRSO has been shown to decrease cancer worry and several investigators have shown decreased sexual functioning and increased vasomotor symptoms, with overall QOL in the immediate postoperative year after RRSO comparable with the general population .…”

Section: Introductionmentioning

confidence: 99%

Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

Powell

Alabaster

et al. 2019

Psycho-Oncology

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Objectives: Assess sexual function, menopausal symptoms, and depression in women with BRCA mutations associated with oophorectomy and menopause status.Methods: Women age 40 and older with BRCA mutations completed a questionnaire with validated measures of sexual activity, menopausal symptoms, depression, and cancer worry. These measures were compared between those with intact ovaries and those who had undergone pre-or post-menopausal risk-reducing salpingooophorectomy (RRSO).Results: Of the 244 women, 21 had intact ovaries and 223 had undergone RRSO. Women with intact ovaries had less menopausal symptoms (Menopausal SymptomChecklist (MSCL) score 14 versus 23, P = .01) but more cancer worry than women who had undergone RRSO (median Cancer Worry Scale (CWS) score 5 versus 4, P < .0001) with no significant difference in sexual activity or function. Compared with women with postmenopausal RRSO, women with premenopausal RRSO were more likely to be sexually active (56.3% versus 42.0%, P =.04) but had similar sexual functioning, including frequency, pleasure and discomfort. Women with premenopausal RRSO were also more likely to report menopausal symptoms (MSCL score 26 versus 19, P = .04) and depression (PHQ-8 score 4 versus 2, P < .001). Factors associated with sexual activity included younger age, lower BMI, living with a partner, and lower depression scores. Higher current depression score was associated with history of depression and more menopausal symptoms.Conclusions: Risk-reducing surgery decreases cancer risk and worry in women with BRCA mutations. Among women undergoing oophorectomy, factors such as age and history of depression were related to reduced sexual activity and increased depression, but menopausal status was not related.

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“…These rates are consistent with those reported in previous studies of individuals at high risk of ovarian cancer owing to family history or a BRCA mutation. 13 In fact, rates of bone disease or bone loss between 46% and 73% have been reported. 13 In contrast, rates of osteopenia and osteoporosis are 49% and 7%, respectively, among individuals aged 50 to 59 years in the general population, suggesting elevated rates of osteopenia among those with a BRCA mutation who have undergone surgical menopause.…”

Section: Discussionmentioning

confidence: 99%

“…13 In fact, rates of bone disease or bone loss between 46% and 73% have been reported. 13 In contrast, rates of osteopenia and osteoporosis are 49% and 7%, respectively, among individuals aged 50 to 59 years in the general population, suggesting elevated rates of osteopenia among those with a BRCA mutation who have undergone surgical menopause. 21 What is striking is the consistent finding in our and prior studies 8,10,11,12 that screening for bone disease following surgery among individuals with a BRCA mutation is not routine.…”

Section: Discussionmentioning

confidence: 99%

“…Although limited by their cross-sectional nature, collectively the data suggest elevated rates of bone disease following oophorectomy, especially among those who were premenopausal at the time of surgery. 8,9,10,11,12,13 There are no standardized guidelines for the management of bone health in this population after surgery. Individuals with a BRCA mutation may be at an elevated risk of BMD decline because of a history of cancer.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Bone Mineral Density After Prophylactic Bilateral Salpingo-Oophorectomy in Carriers of a BRCA Mutation

et al. 2019

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IMPORTANCE Preventive surgery is strongly recommended for individuals with a BRCA mutation at a young age to prevent ovarian cancer and improve overall survival. The overall effect of early surgical menopause on various health outcomes, including bone health, has not been clearly elucidated. OBJECTIVE To evaluate the association of prophylactic bilateral salpingo-oophorectomy with bone mineral density (BMD) loss among individuals with a BRCA mutation. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of participants with a BRCA mutation who underwent oophorectomy through the University Health Network, Toronto, Ontario, Canada, recruited participants from January 2000 to May 2013. Eligibility criteria included having a BRCA mutation, at least 1 ovary intact prior to surgery, and no history of any cancer other than breast cancer. Bone mineral density was measured using dual-energy x-ray absorptiometry before and after surgery. Data analysis began in December 2018 and finished in January 2019. MAIN OUTCOMES AND MEASURES The annual change in BMD from baseline to follow-up was calculated for the following 3 anatomical locations: (1) lumbar spine, (2) femoral neck, and (3) total hip. RESULTS A total of 95 women had both a baseline and postsurgery BMD measurement with a mean (SD) follow-up period of 22.0 (12.7) months. The mean (SD) age at oophorectomy was 48.0 (7.4) years. Among women who were premenopausal at time of surgery (50 [53%]), there was a decrease in BMD from baseline to follow-up across the lumbar spine (annual change, −3.45%; 95% CI, −4.61% to −2.29%), femoral neck (annual change, −2.85%; 95% CI, −3.79% to −1.91%), and total hip (annual change, −2.24%; 95% CI, −3.11% to −1.38%). Self-reported hormone therapy use was associated with significantly less bone loss at the lumbar spine (−2.00% vs −4.69%; P = .02) and total hip (−1.38% vs −3.21; P = .04) compared with no hormone therapy use. Among postmenopausal women at time of surgery (45 [47%]), there was also a significant decrease in BMD across the lumbar spine (annual change, −0.82%; 95% CI, −1.42% to −0.23%) and femoral neck (annual change, −0.68%; 95% CI, −1.33% to −0.04%) but not total hip (annual change, −0.18%; 95% CI, −0.82% to 0.46%). CONCLUSIONS AND RELEVANCE This study found that oophorectomy was associated with postoperative bone loss, especially among women who were premenopausal at the time of surgery. Targeted management strategies should include routine BMD assessment and hormone therapy use to improve management of bone health in this population.

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Bone loss in women with BRCA1 and BRCA2 mutations

Cited by 13 publications

References 14 publications

Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers

Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers

Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

Changes in Bone Mineral Density After Prophylactic Bilateral Salpingo-Oophorectomy in Carriers of a BRCA Mutation

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