Loss of bone density and bone strength following premenopausal risk–reducing bilateral salpingo-oophorectomy:​ a prospective controlled study (WHAM Study)

Jiang, H.<sup>1</sup>; Robinson, D. L.<sup>2</sup>; Lee, P. V. S.<sup>2</sup>; Krejany, E. O.<sup>3</sup>; Yates, C. J.<sup>1,4,5</sup>; Hickey, M.<sup>3</sup>; Wark, J. D.<sup>1,4,5</sup>

Affiliations

¹Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia

²Department of Biomedical Engineering, University of Melbourne, Parkville, Australia

³Department of Obstetrics and Gynaecology, University of Melbourne and Royal Women’s Hospital, Parkville, Australia

⁴Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Australia

⁵Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia

Abstract and keywords

Summary: Prophylactic oophorectomy is recommended for women at high risk for ovarian cancer, but the associated impact on bone health is of clinical concern. This prospective, controlled study demonstrated substantial loss of bone density and bone strength following surgical menopause. Postoperative hormone therapy alleviated, but not fully prevented, spinal bone loss.

Introduction: This prospective study investigated bone health in women following premenopausal oophorectomy.

Methods: Dual-energy x-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), and pQCT-based finite element analysis (pQCT-FEA) were used to assess bone health between systemic hormone therapy (HT) users and non-users after premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) compared with premenopausal controls over 24-month follow-up.

Results: Mean age was 42.4 ± 2.6 years (n = 30) for the surgery group and 40.2 ± 6.3 years for controls (n = 42), and baseline bone measures were similar between groups. Compromised bone variables were observed at 24 months after RRBSO, among which areal bone mineral density (aBMD) at the lumbar spine, tibial volumetric cortical density (Crt vBMD), and tibial bending stiffness (kbend) had decreased by 4.7%, 1.0%, and 12.1%, respectively (all p < 0.01). In non-HT users, significant losses in lumbar spine (5.8%), total hip (5.2%), femoral neck (6.0%) aBMD, tibial Crt vBMD (2.3%), and kbend (14.8%) were observed at 24 months (all p < 0.01). HT prevented losses in kbend, tibial Crt vBMD, and aBMD, except for modest 2.3% loss at the lumbar spine (p = 0.01).

Conclusion: This prospective, controlled study of bone health following RRBSO or premenopausal oophorectomy demonstrated substantial loss of bone density and bone strength following RRBSO. HT prevented loss of bone density and bone stiffness, although there was still a modest decrease in lumbar spine aBMD in HT users. These findings may inform decision-making about RRBSO and clinical management following premenopausal oophorectomy.

Keywords: DXA; Finite element analysis; Hormone replacement; pQCT; Surgical menopause

Links

DOI: 10.1007/s00198-020-05608-5

PubMed: 32856124

WoS: 000565575600001

History

Received: 2020-02-24

Accepted: 2020-08-19

Online: 2020-08-27

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Cited By (1)

Year	Entry
2023	Dao T, Robinson DL, Doyle LW, Lee PVS, Olsen J, Kale A, Cheong JLY, Wark JD. Quantifying bone strength deficits in young adults born extremely preterm or extremely low birth weight. J Bone Miner Res. December 2023;38(12):1800-1808.