Younger women with gynecologic cancers at high risk for osteoporosis 1 year after treatment
Women aged 65 years or younger who underwent surgery and adjuvant chemotherapy for gynecologic cancer appeared at higher risk for osteopenia and osteoporosis as early as 1 year after treatment, according to study results presented at the virtual Society of Gynecologic Cancer Annual Meeting.
“There are safe and effective treatments for osteoporosis available; however, timely identification of those at risk is required for successful treatment. Our data indicate the importance of identifying women at risk soon after cancer treatments — ideally within the first year,” Janelle Sobecki, MD, clinical instructor and fellow of gynecologic oncology in the department of obstetrics and gynecology at University of Wisconsin School of Medicine and Public Health, told Healio.
Current guidelines support routine bone mineral density evaluation every 2 years for women with cancer who undergo treatments that affect ovarian function. However, these data largely are based on research of patients with breast cancer, Sobecki said.
“Nearly all women with gynecologic cancer undergo oophorectomy in addition to other cancer-directed therapies, which are known risk factors for bone loss. Yet, few data exist regarding bone loss in this population,” Sobecki told Healio. “Given [women with gynecologic cancer] undergo CT imaging often throughout their treatment course, we believed opportunistic CT bone mineral density evaluation would be an easy and effective way to investigate bone loss in our patient population.”
Investigators sought to assess long-term changes in bone mineral density and osteoporosis risk among 185 women (median age, 55 years; range, 23-65; mean BMI, 32) who underwent oophorectomy for uterine or ovarian cancer between 2010 and 2014. All women had a baseline CT scan and at least one additional follow-up CT scan.
The majority (78.1%) had ovarian cancer, 78.1% received chemotherapy, 17.1% underwent external beam radiation and 63.6% were alive in 2019.
All women had CT-based L1 trabecular attenuation bone mineral density measurements performed on previous CT scans at baseline and 1 year, 3 years, 5 years and more than 5 years after cancer diagnosis.
Researchers grouped osteoporosis risk into three categories: concerning for osteoporosis (< 100 Hounsfield units [HU]), suggestive of osteopenia (100-150 HU) and normal (> 150 HU).
They used one-sided t-tests to compare baseline bone mineral density with follow-up time points. Predictors of bone mineral density were evaluated through bivariate and multivariate analyses at 1 year, 3 years and 5 years.
Researchers observed significant decreases in bone mineral density from baseline to 1 year (179.4 HU vs. 146.5 HU), 3 years (176 HU vs. 141.9 HU), 5 years (179.1 HU vs. 140.3 HU) and after 5 years (175.7 HU vs. 123.6 HU; P < .001 for all).
Researchers determined 4.3% of women were at increased risk for osteoporosis at baseline. By comparison, the percentage of those at risk increased to 7.4% by 1 year after treatment, 15.7% at year 3, 18% at year 5 and 23.3% after 5 years.
Pretreatment bone mineral density was a significant predictor for osteoporosis risk at 1 year (beta = 0.7; P < .01), 3 years (beta = 0.7; P = .02) and 5 years (beta = 0.8; P < .01). Treatment with chemotherapy predicted bone loss at 1 year (beta = 10.9; P = .03), whereas current smoking status predicted bone loss at 5 years (beta = 52.4; P < .01).
“We plan to further investigate the role of chemotherapy in bone loss in [women with gynecologic cancer], including chemotherapy dose-related bone loss,” Sobecki told Healio. “We also plan to investigate bone loss in women aged older than 65 years undergoing treatment for gynecologic cancer, as they may be at greater risk than their baseline age-related risk.” – by Jennifer Southall
Sobecki J, et al. Abstract 130. Presented at: Society of Gynecologic Cancer Annual Meeting; March 28-31, 2020 (virtual meeting).
Disclosures: Sobecki reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.