1. Nalley, Catlin

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A new study found that half of younger uterine and ovarian cancer survivors are at a higher risk for osteoporosis, according to findings released by the Society of Gynecologic Oncology (Abstract 130).

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"Bone loss is an important issue for women's cancer survivorship, particularly for women who we expect to have long survival," noted Janelle Sobecki, MD, the study's lead author and Gynecologic Oncology Fellow at the University of Wisconsin-Madison. "Identifying bone loss early is important for long-term bone health and prevention of osteoporosis in cancer survivors.


"Current guidelines support routine bone mineral density (BMD) evaluation every 2 years in women with cancer who undergo treatments affecting ovarian function. These guidelines are based almost entirely on research performed in patients with breast cancers," she said. "Women with gynecologic cancer nearly all undergo oophorectomy in addition to other cancer-directed therapy, both known risk factors for bone loss.


"To date, few data exist with regard to bone loss in this population. Given gynecologic cancer patients 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."


Methods, Key Findings

Sobecki and her team evaluated BMD in a retrospective cohort of women 65 years or younger with uterine or ovarian cancer who underwent oophorectomy between 2010 and 2014.


The study included a total of 185 patients, with a median age of 55 years and a mean BMI of 32, who had a baseline CT scan and at least one additional follow-up CT scan. Of these patients, 78.1 percent had ovarian cancer; 78.1 percent received chemotherapy; 17.1 percent underwent external beam radiation; and 63.6 percent remain alive in 2019, according to the researchers.


They reported that BMD significantly decreased between baseline and 1 year, 3 years, 5 years, and more than 5 years. The data showed that half of patients with normal BMD at baseline were at risk for osteopenia or osteoporosis at 5 years. Among the included patients, 4.3 percent had osteoporosis risk at baseline compared to 7.4 percent at 1 year, 15.7 percent at 3 years, 18.0 percent at 5 years, and 23.3 percent at >5 years.


The study authors also found that chemotherapy treatment had the strongest link to decreased BMD, seen 1 year after receiving chemotherapy. Additionally, smoking is also linked to a lower BMD, evident 5 years after cancer treatment.


"Our data indicate half of patients with normal bone mineral density at baseline had risk for osteopenia or osteoporosis at 5 years following treatment for uterine or ovarian cancer," Sobecki said. "[The study also shows] nearly a quarter (23.3%) of women treated for uterine or ovarian cancer are at risk for osteoporosis at 5 years following treatment compared to 4.3 percent at baseline."


"Younger gynecologic cancer survivors experience a significant decrease in BMD and increased osteoporosis risk following treatment, especially in the first year," the investigators wrote. "Our data suggest routine BMD assessments within 1 year following initiation of cancer treatment are warranted in this population. Opportunistic CT-based BMD measurements are a feasible osteoporosis screening tool in women with gynecologic cancer."


When asked if any challenges were encountered over the course of this research, Sobecki noted that, "In order to measure bone loss over time, we were only able to retrospectively evaluate patients who had baseline CT imaging before cancer treatments, as well as CT imaging over time.


"Because of this," she explained, "most patients included were those with more advanced stage cancers as they were more likely to have multiple CT scans over time. This did limit our evaluation. We need to further investigate bone loss in those with lower stage disease."


Implications, Next Steps

There are safe and effective treatments for osteoporosis available; however, timely identification of those at risk is required for successful treatment, according to Sobecki.


"Our findings indicate women 65 years and younger who undergo surgery and adjuvant therapy for gynecologic cancer are at risk for osteopenia and osteoporosis, as soon as 1 year after treatment," she explained. "Our data indicate the importance of identifying women at risk soon after cancer treatments, ideally within the first year."


What are the next steps for this research? Sobecki noted that their study also demonstrated that patients receiving chemotherapy after oophorectomy had significantly decreased BMD and increased rates of osteopenia and osteoporosis.


"We plan to further investigate the role of chemotherapy in bone loss in gynecologic cancer patients, including chemotherapy dose-related bone loss," she told Oncology Times. "We also plan to investigate bone loss in older women (over the age of 65) undergoing treatment for gynecologic cancer as they may be at greater risk than their baseline age-related risk."


Catlin Nalley is a contributing writer.