The Effect of Loss of Estrogen on Trabecular Bone Score in Women At Increased Risk of Breast Cancer

In states of estrogen deficiency bone loss is evident. We investigated two interventions that cause estrogen deprivation in the setting of breast cancer prevention: 1) prophylactic salpingooophorectomy, being the surgical removal of the ovaries and fallopian tubes, and 2) exemestane therapy, which prevents estrogen synthesis in the body. In the literature, bone density loss following these interventions has been studied; however, bone density does not encompass all aspects of bone strength. Our aim was to investigate bone loss after these interventions using a novel measure which assesses bone architecture termed trabecular bone score (TBS). We hypothesized that due to estrogen depletion by prophylactic salpingo-oophorectomy and exemestane, a greater loss in TBS would be observed. One year following prophylactic salpingo-oophorectomy and two years on exemestane did not cause significant loss in TBS. Based on our findings, the clinical use of TBS for detecting small changes in bone is not warranted.

Year	Entry
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Year

Entry

2002

Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J. November 12, 2002;167(suppl 10):S1-S34.

2001

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. February 14, 2001;285(6):785-795.

2011

Hans D, Goertzen AL, Krieg M-A, Leslie WD. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res. November 2011;26(11):2762-2769.

1992

Carter DR, Bouxsein ML, Marcus R. New approaches for interpreting projected bone densitometry data. J Bone Miner Res. February 1992;7(2):137-145.

2014

Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP. Trabecular bone score: a noninvasive analytical method based upon the dxa image. J Bone Miner Res. March 2014;29(3):518-530.